Advancing the Frontiers of Multiple Sclerosis Management: Emerging Immunotherapeutic Strategies

Multiple Sclerosis (MS) is a chronic neurodegenerative disease characterized by inflammation, demyelination, and neuronal loss in the CNS. Despite significant therapeutic advancements, MS remains incurable, especially the progressive forms like Primary Progressive MS (PPMS), due to a lack of understanding of the disease mechanisms and inadequate translational models.

This narrative review assesses literature on MS pathophysiology, phenotypes, diagnostic issues, and new immunotherapeutic strategies, analyzing preclinical and clinical evidence regarding biologics, neuroprotective agents, remyelination methods, advanced imaging, and biomarker development.

Treatment regimens using anti-CD20 monoclonal antibodies such as rituximab, ocrelizumab, and ofatumumab have proven effective in reducing disease activity and slowing progression, especially in PPMS. Additionally, Bruton's tyrosine kinase inhibitors and agents that promote remyelination have the potential to address unmet medical needs. Enhanced imaging techniques, such as MRI and PET, and molecular biomarkers facilitate better disease monitoring and personalized treatment, enabling more tailored therapies that can improve patient outcomes in conditions like MS.

Recent advances emphasize the important role of immune dysregulation, particularly involving B-cell mechanisms, in the progression of MS. Anti-CD20 monoclonal antibodies have demonstrated clinical benefits, effectively reducing disease activity and slowing progression, particularly in progressive MS cases. Nonetheless, challenges such as high costs, limited access, and reduced efficacy in later disease stages persist, especially in resource-constrained healthcare settings.

Emerging immunotherapeutic, neuroprotective, and remyelination-based approaches may improve outcomes in patients with progressive MS. Further, to personalize the MS treatment, we need to combine advanced imaging, biomarker technologies, and real-world clinical data.