Clinical trials of immunosuppression and immunomodulation in multiple sclerosis.

Although clinical trials in multiple sclerosis are extremely difficult to conduct because of the unpredictable course of the disease and the problem of defining and monitoring disease activity, some controlled and several uncontrolled studies suggest that global immunosuppression may result in a small but beneficial effect. After some methodological considerations the results of recent trials are reviewed especially those concerned with the use of cyclophosphamide, azathioprine and cyclosporine. Major improvements in our ability to slow-down disease progression may develop through the administration of more sophisticated, phase-adapted therapies using combinations of different immunosuppressive and modulating agents which should be applied in earlier phases of the disease. Improved monitoring of disease evolution by the addition of magnetic resonance imaging to current clinical scales and by ameliorated immunological techniques is an indispensable prerequisite of any further therapeutic progress.