Current evidence and therapeutic strategies for multiple sclerosis

In the previous two decades several immunomodulatory and immunosuppressive therapies have been shown to favorably impact the inflammatory activity and course of multiple sclerosis. There are now six approved therapies for the disease. Clinical decision-making has become more complex because of the increasing number of available drugs, the lack of head-to-head comparisons that allow direct comparisons of efficacy, and special factors that may influence efficacy such as neutralizing antibodies against beta-interferon preparations. Furthermore, all current therapies are partially effective; therefore, most patients experience breakthrough disease activity while using them, and there are no validated treatment failure definitions or management algorithms. This review outlines current evidence supporting efficacy of available drugs and scenarios for which more studies are required, and highlights the need for emerging therapies and strategies for multiple sclerosis management, including investigative oral and parenteral agents and combination therapy approaches.