Is steroid therapy in multiple sclerosis superior to corticotropin therapy

To the Editor. —We read the special article "Steroid Therapy in Multiple Sclerosis" by Troiano et al 1 in the August 1987 issue of theArchiveswith interest. While we agree that high-dose corticosteroid therapy has a role in the treatment of acute exacerbations in multiple sclerosis (MS), it is unclear if this is superior to corticotropin therapy. Though not stating an unequivocal preference, the authors' point of view is more favorable to corticosteroid treatment. In their comparisons, they focus largely on the adrenal-stimulating action of corticotropin and assume the long-held notion that corticotropin treatment can be considered an indirect way of administering corticosteroids. However, recent studies indicate a more complex situation. Corticotropin has been shown to directly regulate antibody responses 2 and also to potently suppress interferon gamma production in mouse spleen cell cultures. 3 The latter effect is particularly noteworthy, in view of the recent demonstration that treatment