INTENSIVE IMMUNOSUPPRESSION IN PROGRESSIVE MULTIPLE-SCLEROSIS - A RANDOMIZED, 3-ARM STUDY OF HIGH-DOSE INTRAVENOUS CYCLOPHOSPHAMIDE, PLASMA-EXCHANGE, AND ACTH
INTENSIVE IMMUNOSUPPRESSION IN PROGRESSIVE MULTIPLE-SCLEROSIS - A RANDOMIZED, 3-ARM STUDY OF HIGH-DOSE INTRAVENOUS CYCLOPHOSPHAMIDE, PLASMA-EXCHANGE, AND ACTH
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DOI：
10.1056/nejm198301273080401
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发表时间：
1983-01-01
影响因子：
158.5
通讯作者：
WEINER, HL
中科院分区：
文献类型：
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作者：
HAUSER, SL;DAWSON, DM;WEINER, HL
将58例重度、进展性多发性硬化患者前瞻性随机分配至3种治疗方案之一：20例接受静脉注射ACTH，20例接受大剂量静脉注射环磷酰胺+ACTH，18例接受血浆置换、低剂量口服环磷酰胺和ACTH治疗。3组患者的年龄、性别、病程、疾病类型及残疾程度相似。治疗前和治疗6 mo。治疗后1年，测定残疾状态评分、Ambestry指数和功能状态评分，并进行定量神经学检查。在促肾上腺皮质激素组中，6个月时20例患者中有8例稳定或改善。在环磷酰胺-ACTH组中，6个月时20例中有18例。血浆置换组6个月时11/18。1年时18例中有9例。高剂量环磷酰胺加促肾上腺皮质激素在6个月和12个月时阻止疾病进展最有效。(at 12个月，环磷酰胺-ACTH与ACTH，P = 0.004;环磷酰胺-ACTH与血浆置换，P = 0.087）。进行性多发性硬化症可通过环磷酰胺加促肾上腺皮质激素的短期强化免疫抑制来稳定病情。
Patients (58) with severe, progressive multiple sclerosis were prospectively randomized to 1 of 3 treatments: 20 received i.v. ACTH, 20 received high-dose i.v. cyclophosphamide plus ACTH, and 18 were placed on a regimen consisting of plasma exchange, low-dose oral cyclophosphamide, and ACTH. The 3 groups were similar in age, sex, duration, type of disease and degree of disability. Before treatment and 6 mo. and 1 yr after treatment, a disability-status score, ambulation index and functional-status score were determined, and a quantitative neurologic examination was performed. In the ACTH group, the number of patients stabilized or improved was 8 of 20 at 6 mo. and 4 of 20 at 1 yr; in the cyclophosphamide-ACTH group, 18 of 20 at 6 mo. and 16 of 20 at 1 yr; and in the plasma exchange group, 11 of 18 at 6 mo. and 9 of 18 at 1 yr. High-dose cyclophosphamide plus ACTH was most effective in halting progression of the disease at both 6 and 12 mo. (at 12 mo., cyclophosphamide-ACTH vs ACTH, P = 0.004; cyclophosphamide-ACTH vs. plasma exchange, P = 0.087). Progressive multiple sclerosis may be stabilized by short-term, intensive immunosuppression with cyclophosphamide plus ACTH.