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[Still no evidence on the efficacy of immunomodulatory therapy in reducing functional impairment in multiple sclerosis].

Immunomodulatory therapy reduces the rate of relapse in multiple sclerosis (MS) by 30% in the first year of treatment; the effect in the second year is uncertain. Relapse is caused by the effects of inflammation on conduction in the central nervous system. Disability develops later and is mainly caused by axonal degeneration. It is unknown whether immunomodulatory therapy has a beneficial effect on the development of axonal degeneration. We must determine whether immunosuppression reduces disability in patients with MS before intensified therapy with natalizumab, with its associated risk of severe adverse events, is considered.