Evaluation of antithymocyte globulin in acute relapses of multiple sclerosis

Abstract

The findings in this study indicate that therapy with a combination of ACTH and antithymocyte globulin (ATG) should be strongly considered for patients with multiple sclerosis who are in acute relapse, who have an elevation in the ratio of gamma globulin to total protein in cerebrospinal fluid, and who are not responsive to ACTH or corticosteroid alone. Twenty-one patients with acute bouts of multiple sclerosis were randomly allocated and treated under controlled conditions with ACTH alone or ACTH and ATG. While patients in both groups improved significantly for four months after treatment, the patients remaining in the ACTH/ATG group are significantly better than the ACTH group for seven of the first eight posttreatment months.

Multiple Sclerosis Treated with Antithymocyte Globulin — A Five Year Follow-Up

“…The original study used ATG in comparable dosage to that used in intensive immunosuppression, and it was beneficial on a short term basis in acute relapsing M.S. (Seland et al, 1974). Furthermore, the trial found that patients with an elevated gamma globulin to total protein ratio ( > 14%) in their C.S.F.…”

“…This study re-evaluated patients five years after they were treated with ATG. The results of the original prospective study, which included a one year follow-up, have been reported (Seland et al, 1974).…”

“…Following the demonstration of antithymocyte globulin's (ATG) effectiveness in suppressing established experimental allergic encephalomyelitis (Brendeletal., 1969;Landet al, 1969;, it was used to treat the acute relapsing form (Brendel, 1971;Pirofski et al, 1971;Seland et al, 1974;Trouillas et al, 1970) and the chronic progressive form (Walker et al, 1976) of multiple sclerosis (M.S.). The encouraging results of preliminary studies have led to further investigation of immunosuppression in the treatment of M.S.…”

Editorial Review: Therapeutic Trials in Multiple Sclerosis

“…Furthermore, even when proper randomization was accomplished, stratification techniques were generally ignored. As a consequence, important differences occurred in the treatment and control groups in terms of age of onset and age of entry (Hauser et al, 1983), age at entry and duration of disease (Seland et al, 1974), degree of disability (Mertin et al, 1983) and relapse rate (Jacobs et al, 1982).…”