Treatment of multiple sclerosis

Area of Science:

• Neuroimmunology
• Neurology
• Clinical Therapeutics

Background:

• Multiple Sclerosis (MS) is a chronic, inflammatory, demyelinating disease of the central nervous system.
• MS presents with a highly variable clinical course, often characterized by relapsing-remitting episodes followed by progressive disability.
• Current treatments primarily target the inflammatory component, with limited efficacy in halting irreversible disability progression, especially in progressive forms.

Purpose of the Study:

• To review the current understanding of Multiple Sclerosis (MS) clinical courses and therapeutic limitations.
• To highlight the partial effectiveness of existing immunomodulatory and immunosuppressive therapies.
• To emphasize the need for novel therapeutic approaches addressing both inflammatory and non-inflammatory mechanisms of axonal damage in MS.

Main Methods:

• Review of existing literature on Multiple Sclerosis (MS) pathophysiology and treatment outcomes.
• Analysis of the efficacy of current disease-modifying agents in different MS subtypes (RRMS, PPMS).
• Discussion of the limitations of current therapies in addressing axonal damage and progressive disability.

Main Results:

• Immunomodulating and immunosuppressive treatments show partial effectiveness, primarily by reducing inflammatory activity and relapses in relapsing-remitting MS (RRMS).
• These therapies have minimal impact on disability progression in primary progressive MS (PPMS), suggesting mechanisms beyond inflammation contribute to disease progression.
• Axonal damage, potentially independent of inflammation, plays a significant role in irreversible disability in MS.

Conclusions:

• Current treatments for MS are insufficient to halt disease progression, particularly in progressive forms.
• There is a critical need for the development of new therapeutic strategies that target both inflammatory and neurodegenerative pathways.
• Optimizing the use of existing treatments and exploring alternative options are essential for improving recovery and managing MS long-term.