Drugs

, Volume 44, Issue 6, pp 946–962 | Cite as

Interferons in Multiple Sclerosis

A Review of the Evidence
  • Hillel S. Panitch
Review Article

Summary

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system, characterised clinically by relapses and remissions, and leading eventually to chronic disability. Despite an enormous amount of research, the cause of MS remains unknown; however, pathological, genetic, and immunological features have been identified that suggest the disease has an autoimmune basis. Accordingly, current therapy of MS includes corticotrophin or corticosteroids for acute exacerbations, and more potent immunosuppressive drugs for severe cases unresponsive to steroids. All of these agents can cause serious adverse reactions. There is an urgent need for immunotherapy that is less toxic, that can be given early and perhaps indefinitely, and that will prevent relapses and progression of the disease.

Our current knowledge of the effects of interferons (IFNs) in MS is based on the results of laboratory research and clinical therapeutic trials carried out over the past decade. Existing evidence points to the conclusion that the effects of the IFNs in MS are mediated by immunoregulatory rather than antiviral or nonspecific mechanisms. Administration of IFN7 increases the exacerbation rate, and IFNγ as well as other cytokines may be involved in the pathogenesis of MS lesions. In contrast, studies of IFNβ show that it tends to inhibit the activity of IFNγ and appears to prevent disease activity. Intrathecal administration of IFNβ, although effective, is cumbersome and potentially hazardous. A large multicentre placebo-controlled trial of systemic recombinant IFNβ was recently conducted in the US, and the results of the first 2 years of treatment were considered sufficiently encouraging that an application for licensing was submitted to the Food and Drug Administration in June 1992. If approved, it will be the first new agent licensed for clinical use in MS in over 20 years. The study will continue under double-blind conditions for at least another year, and a second trial of systemic recombinant IFNβ therapy is also in progress. These studies should provide definitive answers to questions about the role of IFNs in the pathogenesis of MS, as well as the place of recombinant IFNβ as an effective therapeutic agent.

Keywords

Multiple Sclerosis Interferon Multiple Sclerosis Patient Expand Disability Status Scale Natural Killer Cell Activity 

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Copyright information

© Adis International Limited 1992

Authors and Affiliations

  • Hillel S. Panitch
    • 1
    • 2
  1. 1.Neurology and Research ServicesVA Medical CenterWashington, D.C.USA
  2. 2.Department of NeurologyUniversity of Maryland School of MedicineBaltimoreUSA

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