Silberberg D H
Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia 19104.
Neurology. 1988 Jul;38(7 Suppl 2):24-7.
Azathioprine has the longest continuing history of clinical use in the treatment of multiple sclerosis (MS) of any immunosuppressive therapy besides corticosteroids. To date, 19 clinical trials of azathioprine in MS have been reported, and another eight are under way. A review of the reported trials indicates little evidence for a therapeutic effect in MS. This and the lack of evidence for a specific immune alteration in the pathogenesis of MS are relative contraindications for the use of high risk immunosuppressive therapies in this disease. A further caveat is raised by a recent report suggesting that azathioprine may have contributed to an increased incidence of carcinomas in MS patients treated with this drug. In view of these considerations, perhaps the best position to take at the present time is to encourage investigators already engaged in controlled clinical trials of azathioprine to complete their work, so that this data can be considered before new studies of azathioprine in MS are undertaken.
除皮质类固醇外，硫唑嘌呤在治疗多发性硬化症（MS）方面具有临床应用的最长持续历史。迄今为止，已报道了19项硫唑嘌呤治疗MS的临床试验，另有8项正在进行中。对已报道试验的回顾表明，几乎没有证据显示其对MS有治疗效果。这以及在MS发病机制中缺乏特定免疫改变的证据，是在该疾病中使用高风险免疫抑制疗法的相对禁忌证。最近的一份报告提出了进一步的警示，表明硫唑嘌呤可能导致了使用该药物治疗的MS患者中癌症发病率增加。鉴于这些考虑因素，目前或许最好的做法是鼓励已经在进行硫唑嘌呤对照临床试验的研究人员完成他们的工作，以便在开展硫唑嘌呤治疗MS的新研究之前能够考虑这些数据。
