Immunosuppression with OKT3 in multiplesclerosis: Follow-up after three years

Abstracts 208

CICLOSPORIN A VERSUS AZATH!OPRINE IN MULTIPLE SCLEROSIS -SEVEN YEARS FOLLOW-UP AND LONGTERM SIDE EFFECTS. J HAAS, E STARK, U WURSTER, U PATZOLO, D DOMMASCH, L KAPPOS, S POSER

The German M u l t i c e n t e r Study C i c l o s p o r i n A (CIA) versus A z a t h i o p r i n e (AZA) in M u l t i p l e S c l e r o s i s , f i n i s h e d in March 1986 had revealed no d i f f e r e n c e s in outcome a f t e r two years of t r e a t m e n t . In a longterm f o l l o w - u p we o b s e r v e d t h e course of the disease of the Hannover p a t i e n t s a f t e r the end of the t r i a l . Physical examination was done r e g u l a r l y every s i x months. The s e v e r i t y of the disease was weighted by a r a t i n g s c a l e . The volumes of the MRI l e s i o n s in the f o r e b r a i n hemispheres were determined by t h r e e dimensional computer a s s i s t e d p l a n i m e t r y . I f p o s s i b l e lumbar puncture was repeated. In the AZA group (n=33) the therapy Was d i s c o n t i n u e d step by step, in the CIA group (n=39) a b r u p t l y . In 14 p a t i e n t s CIA therapy was r e e s t a b l i s h e d and AZA t h e r a p y was continued ~in 16 p a t i e n t s . In both groups the o v e r a l l progression was minor. The annual relapse r a t e a f t e r the end of the t r i a l in the CIA group increased, but decreased f u r t h e r in the AZA group. In the CIA group 6 p a t i e n t s are now bound to a wheelc h a i r versus 10 of the AZA group. MRI l e s i o n s were diminished in both groups. M i l d h y p e r t e n s i o n p e r s i s t e d in 7 of the non r e t r e a t e d CIA p a t i e n t s , but none had e l e v a t e d serum c r e a t i n i n e . The o v e r a l l t o l e r a n c e of CIA in the 14 r e t r e a t e d p a t i e n t s was v e r y s a t i s f a c t o r y .

210

I M M U N O S U P P R E S S l O N WITH OKT3 IN MULTIPLE SCLEROSIS: FOLLOW-UP AFTER THREE YEARS. GPA RICE, B W E I N S H E N K E R , GC EBERS (LONDON, CANADA)

Eighteen patients with severely progressive multiple sclerosis (MS) were treated with intravenous Muromonab OKT3 (5 mg daily for 10 days), in an unblinded trial. Despite the severe initial side effects, which included hypotension, nausea, vomiting, malaise, fever, chills, rash and edema, and prominent lymphokine release (gamma interferon and tumour necrosis factor), disability scores (Kurtzke) and magnetic resonance imaging changed surprisingly little in the first ten days. All patients worsened by approximately one Kurtzke point during the first ten days of treatment. At 12 months, 4 were worse by a full Kurtzke point. This included two deaths attributed to MS. At 36 months, 5 of the original group had deteriorated by a full point. This outcome is not significantly different from that expected in our population of patients with progressive disease. Monophasic T-cell depletion with OKT3 is ineffective in patients with progressive MS. If immunosuppression is going to alter the natural history of multiple sclerosis, continuous or periodic treatment is likely necessary. xxJv