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This chapter summarizes the state of knowledge for five autoimmune diseases or syndromes affecting the nervous system: multiple sclerosis, systemic lupus erythematosus, Guillain–Barree syndrome, myasthenia gravis, and chronic inflammatory demyelinating polyradiculoneuropathy. Treatment strategies and specific treatment options for each of these diseases are discussed. Among the treatment options, some target disease-specific pathogenic features, while others target features shared with other diseases. Examples of the former are cholinesterase inhibitors for myasthenia gravis, including an anti-sense biologic in development, and a double-stranded DNA-based toleragen, abetimus sodium, being developed for systemic lupus erythematosus. Examples of therapeutics with a broader range of potential indications are a monoclonal antibody to the B cell receptor for CD20, rituximab, and the guanosine nucleotide inhibitor mycophenolate mofetil. While small-molecule drugs clearly dominate pharmaceuticals, biologics (biopharmaceuticals) dominate the field of new and emerging treatment options for autoimmune disease. Of the new biologics for autoimmune disease, the majority are humanized monoclonal antibodies, and most of these are against proinflammatory cytokines or their receptors. Other monoclonal antibodies are against receptors on B or T cells; only one is against an adhesion molecule. Many of the currently available treatment options are agents already approved for another indication, and are being evaluated in clinical trials for one or more autoimmune diseases of the nervous system. These include antineoplastic agents, immunosuppressants for transplant medicine, and, not surprisingly, agents for the treatment of other autoimmune diseases, such as rheumatoid arthritis. |
