The Present Status of ACTH Therapy in Multiple Sclerosis

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Abstract
The efficacy of the treatment of multiple sclerosis by ACTH is demonstrated in a series of 128 patients. Ninety-four were treated with a high-dosage regime, 16 with a low-dosage schedule, and 18 were untreated controls. It was shown that by administration of an adequate schedule of ACTH consisting of a high-dosage phase, followed by a permanent maintenance phase, the disease could be modified. Of the 94 high-dosage treated patients, 78 (83%) showed various degrees of improvement which varied from slight to marked. The degree of improvement was measured by the 9% change in the Alexander Disability Score: slight being defined as a reduction of score by 10-24% occurring in 19 patients; moderate: 25 to 39%, occurring in 32 patients; marked: 40% or better, in 27 patients. Sixteen patients were not improved. The distribution of the 3 grades of improvement was consistent in the 3 subseries composing the entire high-dosage series of 94 patients. Comparison of high-dosage and low-dosage treatment after nearly equal intervals revealed the markedly greater effectiveness of the high-dosage regimen. These findings suggested that a critical dosage was necessary for remission of this disease. Study of daily 17-hydroxycorticoid excretion, taken as a measure of adrenocortical activity, in 12 high-dosage patients revealed a general course of phasic rises and falls, denoted as peaks and troughs, which showed an over-all relationship to the nature, timing and degree of the therapeutic effects and to the 3 groups of side effects observed during treatment.