Therapeutic trials in multiple sclerosis.

Several recently completed clinical trials are reported to demonstrate beneficial treatment with immunosuppressive therapy in multiple sclerosis (MS). The enthusiasm generated by these reports may motivate investigators to further such trials even in the face of the appreciable expense, time and risk involved. Of at least equal concern, clinicians are proceeding to treat individual MS patients without adequate evaluation of the claims. Critical appraisals of available data and proposals for future therapeutic endeavors therefore seem in order and are made in this paper

HLA-typing in multiple sclerosis sibling pairs.

40 sibling pairs with multiple sclerosis (MS) from 36 families were typed for HLA antigens. The frequency of haplotypic sharing in this population-based group of patients differed little from that expected by chance. The findings are strong evidence against a single MS susceptibility gene closely linked to HLA. This evidence conflicts with previous pooled data which have been considered to prove the existence of such a gene and questions the validity of such data in HLA family studies. © 1982

A population-based study of multiple sclerosis in twins.

Results from studies of twin concordance in multiple sclerosis have not conclusively differentiated between environmental and genetic factors that determine susceptibility to the disease. Published studies that have been based on case finding by public appeal have been characterized by difficulties in ascertainment. The data reported here are from a large population-based study of multiple sclerosis in twins, in which ascertainment has been relatively unbiased and the cooperation of patients nearly complete. A total of 5463 patients attending 10 multiple sclerosis clinics across Canada were surveyed. Twenty-seven monozygotic and 43 dizygotic twin pairs were identified, and the diagnosis of multiple sclerosis was verified by examination and laboratory investigation. Seven of 27 monozygotic pairs (25.9 percent) and 1 of 43 dizygotic pairs (2.3 percent) were concordant for multiple sclerosis. The concordance rate for 4582 nontwin siblings of patients at two multiple sclerosis clinics was 1.9 percent, closely paralleling the concordance rate in dizygotic twins. To the extent that the difference in concordance rates between monozygotic and dizygotic twins indicates genetic susceptibility, the results of this study show a major genetic component in susceptibility to multiple sclerosis