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 Mu l t i cen te r Study C ic lospor in A (CIA) versus Azath iopr ine (AZA) in M u l t i p l e Sc le ros is , f i n i shed in March 1986 had revealed no d i f f e rences in outcome a f t e r two years of t reatment . In a longterm fo l low-up we o b s e r v e d t h e course of the disease of the Hannover pa t i en ts a f t e r the end of the t r i a l . Physical examinat ion 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 ra t i ng scale. The volumes of the MRI les ions in the fo reb ra in hemispheres were determined by three dimensional computer ass is ted p lan imet ry . I f poss ib le lumbar puncture was repeated. In the AZA group (n=33) the therapy Was discont inued step by step, in the CIA group (n=39) abrup t l y . In 14 pa t i en ts CIA therapy was rees tab l ished and AZA therapy was continued ~in 16 pa t i en ts . In both groups the ove ra l l progression was minor. The annual relapse rate 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 pa t ien ts are now bound to a wheel- cha i r versus 10 of the AZA group. MRI les ions were diminished in both groups. Mi ld hypertension pers is ted in 7 of the non re t reated CIA pa t i en ts , but none had e levated serum c r e a t i n i n e . The ove ra l l to le rance of CIA in the 14 re t rea ted pa t ien ts was very s a t i s f a c t o r y .

210 IMMUNOSUPPRESSlON WITH OKT3 IN MULTIPLE SCLEROSIS: FOLLOW-UP AFTER THREE YEARS. GPA RICE, B WEINSHENKER, 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.

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