Clinical Status and CNS Adverse Drug Report of Sphingosine-1-Phosphate receptor modulators in multiple sclerosis

A novel class of immunomodulatory agents like Sphingosine-1-phosphate receptor (S1PR) modulators has appeared as primarily utilized in the management of relapsing forms of multiple sclerosis (MS) by inhibiting lymphocyte egress from lymph node and reducing peripheral T cell encroachment on the CNS. The first accepted oral S1P modulator, Fingolimod has demonstrated significant efficacy in reducing relapse rates and MRI lesion activity in large-scale clinical trials. Subsequent development of more selective agents, such as siponimod, ozanimod, and ponesimod, has further enhanced therapeutic outcomes by minimizing off-target effects while preserving efficacy. In this review, the role of S1PR modulators in MS management, results from clinical trials, associated CNS adverse effects, and their expanding potential have been discussed and summarized.