Therapies for multiple sclerosis

Multiple sclerosis (MS) is an idiopathic inflammatory demyelinating disease of the central nervous system. It is one of the leading causes of neurologic disability, particularly in young adults, and is presumed to be autoimmune. This chapter discusses the evidence supporting the use of the MS therapies. It presents clinical scenarios for the following: clinically isolated syndrome, interferon-beta and glatiramer acetate for relapsing-remitting multiple sclerosis, natalizumab and fingolimod, teriflunomide and dimethyl fumarate, secondary progressive MS, primary progressive MS, and dalfampridine. Disease-modifying therapies are all effective for reducing the annual relapse rate of relapsing-remitting disease (RRMS). In summary, substantial progress has been made toward halting inflammatory disease activity in RRMS but future therapies will need to focus on SPMS and PPMS in order to meet the major unmet needs, particularly accumulation of neurological disability, of patients with multiple sclerosis.