Multiple sclerosis, often called MS, is a disease that affects the brain and spinal cord. It happens when the immune system mistakenly attacks the central nervous system. This can damage myelin, the protective covering around nerves, and lead to symptoms such as vision problems, numbness, weakness, fatigue, and trouble with movement.
A recent review article in Frontiers in Neurology looked at how MS treatment has changed over the past 30 years. The authors explain that MS treatment has moved far beyond the older injectable medications that were once the main option. Today, there are oral medications, infusion therapies, and newer high-efficacy treatments that target the immune system in different ways.
The review also makes one thing clear: there is still no cure for MS. Current treatments are mainly designed to slow the disease, reduce relapses, and limit damage over time.
What Is Multiple Sclerosis?
MS is an autoimmune disease, which means the body’s immune system attacks its own tissues. In MS, the immune system targets parts of the central nervous system, including the brain, spinal cord, and optic nerves.
MS can look different from person to person. Some people have relapses, which are periods when symptoms suddenly appear or get worse. Others may develop a more progressive form, where disability slowly builds over time.
The review explains that MS has different clinical forms, including relapsing-remitting MS, primary progressive MS, and secondary progressive MS. It also notes that MS activity can be described as “active” or “not active” based on relapses or MRI findings.
How MS Treatment Has Changed
For many years, MS treatment focused on older injectable medications, such as interferons and glatiramer acetate. These drugs helped reduce disease activity, but they had to be injected and were not always strong enough for people with more active disease.
Over time, more options became available. The review describes FDA-approved oral medications, including fumarates, teriflunomide, and S1P receptor modulators. These treatments gave patients alternatives to injections and targeted the immune system in different ways.
Newer high-efficacy treatments have also changed the treatment landscape. Some of these medications work by reducing or depleting certain immune cells, including B cells, which are now understood to play an important role in MS. These therapies may be especially useful for people with more active disease.
What Disease-Modifying Therapies Are Meant To Do
MS medications are often called disease-modifying therapies, or DMTs. These treatments do not cure MS. Instead, they are meant to reduce inflammation, lower the chance of relapses, and help prevent new injury to the nervous system.
The review states that the main goal of current DMTs is to “quiet the disease” by reducing inflammation, myelin injury, and relapses. It also notes that earlier treatment may help reduce the onset of disability, and that earlier use of high-efficacy therapy may be more successful than traditional approaches for some patients.
This does not mean one treatment is best for everyone. MS is a complex disease, and treatment choices depend on many factors, including disease activity, age, risk of side effects, pregnancy plans, and personal preferences.
Why Progressive MS Is Still Challenging
Progressive MS remains harder to treat than relapsing forms of the disease. One reason is that progressive MS may involve more long-term nerve damage and neurodegeneration, not just active inflammation.
The review explains that treatments for progressive MS have been more challenging, especially for inactive disease and older patients with MS. Many current therapies are better at targeting inflammation than repairing damage that has already happened.
This is why researchers are looking beyond relapse prevention. Future treatments may need to protect nerves, repair myelin, or target inflammation inside the central nervous system more effectively.
What New Treatments Are Researchers Studying?
The review highlights several emerging areas of MS research. These include Bruton’s tyrosine kinase inhibitors, also called BTK inhibitors, which may be able to enter the central nervous system and affect immune activity in new ways.
Researchers are also studying autologous hematopoietic stem cell transplantation, a treatment approach that aims to reset parts of the immune system. Other areas of research include remyelination, which focuses on repairing damaged myelin, and neuroprotection, which focuses on protecting nerve cells from further damage.
These approaches are still being studied. They are not the same as saying MS can be cured. But they show that MS research is moving toward more targeted treatment strategies.
How can I apply this information?
If you or someone you know has MS, the science highlighted in the review article is a reminder that treatment options have expanded a lot. MS care is no longer limited to one type of medication.
It may be helpful to ask a healthcare professional about the goals of treatment, whether the disease appears active, what side effects to watch for, and how treatment choices may change over time.
For the general public, the main takeaway is simple: MS treatment has improved, but it is still complex. Current treatments can help reduce disease activity, but progressive MS and long-term nerve repair remain major challenges.
The future of MS care may depend not only on controlling the immune system, but also on finding better ways to protect and repair the nervous system.
Source:
Yang JH, Rempe T, Whitmire N, Dunn-Pirio A, Graves JS. Therapeutic advances in multiple sclerosis. Front Neurol. 2022;13:824926. Accessed by: https://doi.org/10.3389/fneur.2022.824926
