Spotlight series: pivotal trials through today's knowledge--adrenocorticotrophic hormone.

Forty-five years ago the first large multicentre, randomized, double-blinded, controlled trial of a potential therapy for multiple sclerosis (MS) was completed testing corticotrophin versus placebo. It demonstrated the feasibility of such a trial in an illness which is as variable, from patient to patient, as MS. Adrenocorticotrophic hormone was soon replaced by intravenous methylprednisolone (IVMP) as therapy for acute exacerbations, to control acute inflammatory responses. Long-term therapy with corticosteroids is fraught with complications. Pulsed IVMP has been widely used as an alternative, but few formal studies have been done. One, however, suggested that treated patients had less brain atrophy, and further study of this technique may be indicated.