Current immunosuppressive therapy of autoimmune disease is frequently hampered by insufficient response to treatment, relapse at cessation of treatment and adverse effects of therapy such as toxicity and over-immunosuppression. These difficulties will be overcome by treating diseases earlier in their natural history, before the autoimmune response has become irreversible.
At this early stage of treatment only drugs with low toxicity should be used. Present hopes rely more on monoclonal antibodies than on chemical immunosuppressants that could substitute for the reference drugs cyclosporin (in T cell-mediated disease) and cyclophosphamide (in antibody-mediated disease). However, only a few monoclonal antibodies are presently available, and the possibility of using them for long term treatment is still under investigation.
Undoubtedly the final goal for treatment of autoimmune disease is to restore broken-down tolerance to self antigens, perhaps by combining administration of monoclonal antibodies and soluble autoantigen or by oral administration of the autoantigen. This strategy requires, however, that the target autoantigen of each autoimmune disease is identified. At present this is the case for very few diseases.