Relapsing-remitting MS is thought to be primarily an inflammatory disease of myelin in the CNS. The disease process is characterized by periodic relapses followed by complete or incomplete recovery. Simultaneously, however, irreversible axonal damage and transection are known to occur (Trapp et al., 1998). Controlling inflammation early in the disease may also reduce the damage to axons (Coyle, 2008). The medications that are currently available to treat MS appear to be most effective during the early, inflammatory phase of MS, becoming less potent as the disease transitions to a more neurodegenerative process.
Since 1993, 16 medications have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of relapsing forms of MS (Jeffery, 2013), one of which has also been approved for primary progressive MS. The information presented here is designed to allow a side-by-view of medication options without suggesting inter-medication comparisons, except where specifically supported by the results of head-to-head clinical trials. Comparing the efficacy of medications across trials is misleading because of key differences in the populations, outcome measures, and statistical analyses used in the studies.
FDA-approved disease-modifying therapies (DMTs)
The FDA has approved more than a dozen agents for the treatment of relapsing forms of MS, one of which is also approved for primary progressive MS, and another is also approved for secondary progressive MS. Of these, some are delivered by injection and some by infusion, while others oral.
MS Coalition Evidence-Based Consensus Paper on DMTs
The Multiple Sclerosis Coalition has published an evidence-based consensus paper entitled The Use of Disease-Modifying Therapies in Multiple Sclerosis: Principles and Current Evidence. A Consensus Paper by the Multiple Sclerosis Coalition. This document was developed and endorsed by the eight Coalition member organizations, and subsequently endorsed by the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS). The paper is designed to: summarize current evidence about disease modification in MS; highlight the importance of early and ongoing treatment; and provide support for broad access to FDA-approved MS disease-modifying therapies for people with MS in the United States. A companion summary paper for general audiences is currently under development.
American Academy of Neurology Practice Guidelines for the Use of DMTs
In April 2018 the American Academy of Neurology (AAN) published practice guidelines
for the use of disease modifying therapies for adults with multiple sclerosis. These guidelines have been endorsed by the National MS Society and Multiple Sclerosis Association of America. The guidelines address starting, switching and stopping disease modifying therapies for adults with clinically isolated syndrome, relapsing-remitting MS and progressive forms of MS. The full guidelines and summaries are available for clinicians and patients.
Drug development pipeline
compounds currently under investigation for therapeutic use in MS.