Emerging Therapies for Multiple Sclerosis

Abstract There is no field of neurology expanding faster than the treatment of multiple sclerosis (MS). From no treatments nearly 20 years ago, we have an ever-expanding list of more than a dozen approved treatments for relapsing forms of disease and several more to be approved or complete their studies within the next couple of years (>1500 studies are listed on www.clinicaltrials.gov ). Treatments have moved beyond the first-line immunomodulatory agents to more sophisticated drugs that can block cell trafficking to the central nervous system, more specifically deplete the autoimmune cells while sparing normal immune function, interfere with cytokine or chemokine release, or offer neuroprotection and even remyelination. This chapter will review some of the more imminently available therapies for MS, but will hardly touch some of the exciting fields currently in development such as cell-based therapies. In addition to reviewing the recent data, it is important to position the various treatments such that a clinician can understand where in the disease process each may be used effectively.