Serial immune evaluation of cyclosporine- and placebo-treated multiple sclerosis patients

During an ongoing clinical trial of cyclosporine (CsA) immunosuppression therapy for chronic progressive multiple sclerosis (MS), a comparison was made of the immune responses of 18 CsA- and 18 placebo (P)-treated MS patients. Patients randomized to receive either CsA or P had identical entry immune profiles. However, these MS patients displayed significantly increased T-helper: T-suppressor (T_H : T_S) ratios (P < 0.01), percentage (%) active-T (P < 0.01), % Ia⁺-T (P < 0.05) and % Ta1⁺-T (P < 0.01) cell phenotypes when compared to age-matched normal controls. Further, the MS-P-treated patients displayed significant increases (all P < 0.01) in % pan-T, % helper-T, % active-T and % Ta1⁺-T cell phenotypes as well as panel mixed lymphocyte culture (panel MLC) functional responsiveness from entry to cumulative 12-month study data. In contrast, the MS-CsA-treated patients only displayed an increased % pan-T cell phenotype. The cumulative 12-month follow-up data showed that the MS-P-treated patients displayed significantly higher immune parameters than the MS-CsA-treated patients for % pan-T (P < 0.05), % helper-T (P < 0.01), T_H : T_S ratio (P < 0.05), % active-T (P < 0.01), % Ta1⁺-T cells (P < 0.01) and panel MLC stimulation index (P < 0.01). Thus, MS-CsA-treated patients did not display the progressive immune activation seen on serial evaluation during the follow-up time period that characterized the placebo-treated MS group.