Recent advances in the management of multiple sclerosis




Multiple sclerosis, Drugs promoting remyelination, Non-pharmacological measures, Pharmacotherapy of MS, Recent advances


Every 5 minutes, someone somewhere in the world is diagnosed with an inflammatory, demyelinating, neurodegenerative disorder known as multiple sclerosis (MS). MS was historically known as "La sclèrose en plaques" which involves the central nervous system (the brain and the spinal cord). It is always considered to be a disease of adulthood but nowadays pediatric MS is also gaining popularity. It is the most common non-traumatic chronic disabling disease of adults. MS is said to have etiology of multifactorial origin. of the myelin structure thereby producing a dysregulated immune system. MS is an ongoing disease with episodes of relapses and remissions whereas the basic pathophysiology remains increasing over time. Since the pathophysiology of MS is very complex, it makes the pharmacotherapy part bit difficult. MS therapy is disease subtype-specific. The drugs which were previously approved for MS lacks efficacy and sometimes possess serious adverse effects and thereby creating lacunae in treating MS patients include the need for a drug with better efficacy especially it should be evidence-based. There are several new drugs approved for the treatment of MS in recent times especially over the past 5-8 years and 'n' number of new molecules being tried in clinical trials. In this review, an effort was made to discuss MS epidemiology, potential etiological factors, pathophysiology, clinical aspects of MS before moving on to pharmacotherapy and other non-pharmacological management of MS. A special elaborative note on recently approved drugs and drugs under pipeline has been discussed in this review.

Author Biography

Reka Deva, Department of Pharmacology, MGMCRI, Puducherry, India

Senior Resident, Department of Pharmacology


Dobson R, Giovannoni G. Multiple sclerosis-a review. Eur J Neurol. 2019;26(1):27-40.

Ramagopalan SV, Dobson R, Meier UC, Giovannoni G. Multiple sclerosis: risk factors, prodromes, and potential causal pathways. Lancet Neurol. 2010;9(7):727-39.

Hollenbach JA, Oksenberg JR. The immunogenetics of multiple sclerosis: a comprehensive review. J Autoimmun. 2015;64:13-25.

Lang HL, Jacobsen H, Ikemizu S, Andersson C, Harlos K, Madsen L, et al. A functional and structural basis for TCR cross-reactivity in multiple sclerosis. Nat Immunol. 2002;3(10):940-3.

Neumann H, Medana IM, Bauer J, Lassmann H. Cytotoxic T lymphocytes in autoimmune and degenerative CNS diseases. Trends Neurosci. 2002;25(6):313-9.

Kuhlmann T, Ludwin S, Prat A, Antel J, Brück W, Lassmann H. An updated histological classification system for multiple sclerosis lesions. Acta Neuropathol. 2017;133(1):13-24.

Höftberger R, Lassmann H. Inflammatory demyelinating diseases of the central nervous system. Handb Clin Neurol. 2017;145:263-83.

Kuhn S, Gritti L, Crooks D, Dombrowski Y. Oligodendrocytes in development, myelin generation and beyond. Cells. 2019;8(11):1424.

National Multiple Sclerosis Society. Fact sheet: Types of MS. Available at: Accessed on 3 June 2022.

Lublin FD, Reingold SC, Cohen JA, Cutter GR, Sørensen PS, Thompson AJ, et al. Defining the clinical course of multiple sclerosis: the 2013 revisions. Neurology. 2014;83(3):278-86.

Walton C, King R, Rechtman L, Kaye W, Leray E, Marrie RA, et al. Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS. Mult Scler. 2020;26(14):1816-21.

Jameson JL. Harrison's principles of internal medicine. McGraw-Hill Education; 2018.

Noseworthy JH, Lucchinetti C, Rodriguez M, Weinshenker BG. Medical progress. Multiple Sclerosis. N E J Med. 2000;343(13):938-52.

Doshi A, Chataway J. Multiple sclerosis, a treatable disease. Clin Med. 2017;17(6):530.

Anlar O. Treatment of multiple sclerosis. CNS Neurol Disorders-Drug Target. 2009;8(3):167-74.

Lattanzi S, Cagnetti C, Danni M, Provinciali L, Silvestrini M. Oral and intravenous steroids for multiple sclerosis relapse: a systematic review and meta-analysis. J Neurol. 2017;264(8):1697-704.

Griffith TD, Newman PK. Steroids in multiple sclerosis. J Clinic Pharm Therapeut. 1994;19(4):219-22.

Gholamzad M, Ebtekar M, Ardestani MS, Azimi M, Mahmodi Z, Mousavi MJ, et al. A comprehensive review on the treatment approaches of multiple sclerosis: currently and in the future. Inflamm Res. 2019;68(1):25-38.

Brusaferri F, Candelise L. Steriods for multiple sclerosis and optic neuritis: a meta-analysis of randomized controlled clinical trials. J Neurol. 2000;247(6):435-42.

Brod SA, Morales MM. Bio-equivalence of IM and SQ HP Acthar® Gel. Biomed Pharmacother. 2009;63(4):251-3.

Weiner HL, Dau PC, Khatri BO, Petajan JH, Birnbaum G, McQuillen MP, et al. Double‐blind study of true vs. sham plasma exchange in patients treated with immunosuppression for acute attacks of multiple sclerosis. Neurology. 1989;39(9):1143.

Kieseier BC. The mechanism of action of interferon-β in relapsing multiple sclerosis. CNS Drug. 2011;25(6):491-502.

Ebers GC. Randomised double-blind placebo-controlled study of interferon β-1a in relapsing/remitting multiple sclerosis. Lancet. 1998;352(9139):1498-504.

Oh J, Calabresi PA. Emerging injectable therapies for multiple sclerosis. Lancet Neurol. 2013;12(11):1115-26.

Butzkueven H, Kappos L, Pellegrini F, Trojano M, Wiendl H, Patel RN, et al. Efficacy and safety of natalizumab in multiple sclerosis: interim observational programme results. J Neurol Neurosurg Psychiat. 2014;85(11):1190-7.

McGuigan C, Craner M, Guadagno J, Kapoor R, Mazibrada G, Molyneux P, et al. Stratification and monitoring of natalizumab-associated progressive multifocal leukoencephalopathy risk: recommendations from an expert group. J Neurol Neurosurg Psychiat. 2016;87(2):117-25.

Kappos L, Li D, Calabresi PA, O'Connor P, Bar-Or A, Barkhof F, et al. Ocrelizumab in relapsing-remitting multiple sclerosis: a phase 2, randomised, placebo-controlled, multicentre trial. Lancet. 2011;378(9805):1779-87.

Ruck T, Bittner S, Wiendl H, Meuth SG. Alemtuzumab in multiple sclerosis: mechanism of action and beyond. Int J Molecul Sci. 2015;16(7):16414-39.

Milo R. Therapies for multiple sclerosis targeting B cells. Croatian Med J. 2019;60(2):87.

Cohen JA, Chun J. Mechanisms of fingolimod's efficacy and adverse effects in multiple sclerosis. Ann Neurol. 2011;69(5):759-77.

Comi G, Kappos L, Selmaj KW, Bar-Or A, Arnold DL, Steinman L, et al. Safety and efficacy of ozanimod versus interferon beta-1a in relapsing multiple sclerosis (SUNBEAM): a multicentre, randomised, minimum 12-month, phase 3 trial. Lancet Neurol. 2019;18(11):1009-20.

Confavreux C, O'Connor P, Comi G, Freedman MS, Miller AE, Olsson TP, et al. Oral teriflunomide for patients with relapsing multiple sclerosis (TOWER): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol. 2014;13(3):247-56.

Toosy A, Ciccarelli O, Thompson A. Symptomatic treatment and management of multiple sclerosis. Handbook of clinical neurology. Elsevier; 2014: 513-62.

Samkoff LM, Goodman AD. Symptomatic management in multiple sclerosis. Neurolog Clin. 2011;29(2):449-63.

D’Amico E, Leone C, Caserta C, Patti F. Oral drugs in multiple sclerosis therapy: an overview and a critical appraisal. Expert Rev Neurotherapeut. 2015;15(7):803-24.

Kremer D, Küry P, Dutta R. Promoting remyelination in multiple sclerosis: current drugs and future prospects. Multiple Sclerosis J. 2015;21(5):541-9.

U. S. National Library of Medicine. Fact sheet: Multiple sclerosis. Available at: Accessed on 3 June 2022.

Muraro PA, Martin R, Mancardi GL, Nicholas R, Sormani MP, Saccardi R. Autologous haematopoietic stem cell transplantation for treatment of multiple sclerosis. Nature Rev Neurol. 2017;13(7):391.

Genc B, Bozan HR, Genc S, Genc K. Stem cell therapy for multiple sclerosis. Tissue Engineer Regenerat Med. 2018:145-74.




How to Cite

Deva, R., & Rajendran, P. (2022). Recent advances in the management of multiple sclerosis. International Journal of Basic & Clinical Pharmacology, 11(5), 520–531.