Adjunctive Non-Disease-Modifying Therapies in Multiple Sclerosis: Immunometabolic, Neuroprotective and...

Area of Science:

• Neuroscience
• Immunology
• Pharmacology

Background:

• Standard disease-modifying therapies (DMTs) for multiple sclerosis (MS) primarily target inflammation but have variable effects on neurodegeneration and long-term symptoms.
• Adjunctive non-DMT strategies are explored to address biological processes beyond conventional immunomodulation in MS.

Purpose of the Study:

• To review pharmacological agents, nutraceuticals, and bioactive compounds as adjunctive interventions in MS.
• To emphasize immunometabolic regulation and remyelination mechanisms.
• To assess the translation of mechanistic rationale into clinical outcomes for MS treatment.

Main Methods:

• Narrative review of experimental models, translational studies, and clinical trials.
• Examination of repurposed drugs and metabolic modulators.
• Focus on effects related to immune responses, glial function, and myelin repair.

Main Results:

• Most adjunctive strategies do not show consistent disease-modifying effects in MS.
• Some interventions impact specific pathways relevant to neuroinflammation, cellular metabolism, and oligodendrocyte biology.
• Outcomes vary based on disease stage, treatment duration, and endpoints.

Conclusions:

• Adjunctive non-DMT strategies for MS are investigational.
• Further evaluation in biologically stratified clinical studies is required.
• These approaches may influence specific MS pathophysiology pathways but require more evidence for consistent therapeutic benefit.