Disease-modifying treatments for multiple sclerosis – a review of approved medications

BACKGROUND AND PURPOSE There is still no curative treatment for multiple sclerosis (MS), but during the last 20 years eight different disease-modifying compounds have been approved for relapsing-remitting MS (RRMS). METHODS A literature search was conducted on published randomized controlled phase III trials indexed in PubMed on the approved medications until 21 May 2015. RESULTS In this review the mode of action, documented treatment effects and side effects of the approved MS therapies are briefly discussed. CONCLUSIONS Based on current knowledge of risk-benefit of the approved MS medications, including factors influencing adherence, it is suggested that oral treatment with dimethyl fumarate or teriflunomide should be preferred as a starting therapy amongst the first-line preparations for de novo RRMS. In the case of breakthrough disease on first-line therapy, or rapidly evolving severe RRMS, second-line therapy with natalizumab, fingolimod or alemtuzumab should be chosen based on careful risk-benefit stratification.