Disease-Modifying Therapies in Multiple Sclerosis Management

Multiple sclerosis (MS) is a chronic immune-mediated disorder characterised by inflammation, demyelination and neurodegeneration of the central nervous system. Disease-modifying therapies (DMTs) aim to alter the underlying disease course by reducing the frequency of clinical relapses, delaying accumulation of disability and limiting radiological lesion burden. Over the past two decades, a spectrum of agents with distinct mechanisms—ranging from injectables and oral small molecules to monoclonal antibodies—has transformed MS care. Early intervention with a suitably potent DMT is now widely regarded as critical to preserve neurological function and to forestall irreversible tissue damage. Treatment selection is guided by patient age, clinical phenotype, prognostic markers and tolerability considerations, and is increasingly informed by real-world registry data and head-to-head comparative studies. Advances in imaging and fluid biomarkers are refining monitoring strategies, while emerging insights into immune cell trafficking and repair mechanisms hold promise for the development of therapies that combine immunomodulation with remyelination. Global consensus efforts stress the importance of individualised treatment sequencing to maximise long-term benefit and maintain a favourable benefit-risk profile.

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Disease-Modifying Therapies in Multiple Sclerosis Management publication trend

The graph below shows the total number of articles in disease-modifying therapies in multiple sclerosis management across all publications each year (not limited to Nature Index journals).

Technical terms

Disease-modifying therapy (DMT): A treatment designed to alter the long-term course of MS by reducing inflammatory activity and neurodegeneration.

No evidence of disease activity (NEDA): A composite outcome encompassing absence of relapses, disability progression and new or enlarging MRI lesions.

High-efficacy DMT (HE-DMT): A class of therapies with potent immunomodulatory or immunosuppressive effects, aimed at maximal suppression of disease activity.

Relapse: An acute or subacute episode of neurological dysfunction attributable to inflammatory demyelination in MS, lasting at least 24 hours.

Expanded Disability Status Scale (EDSS): A quantifiable scale ranging from 0 to 10 used to assess disability in people with MS based on neurological examination.

References

1. Early use of high-efficacy disease‑modifying therapies makes the difference in people with multiple sclerosis: an expert opinion. Journal of Neurology (2022).
2. Early High Efficacy Treatment in Multiple Sclerosis Is the Best Predictor of Future Disease Activity Over 1 and 2 Years in a Norwegian Population-Based Registry. Frontiers in Neurology (2021).
3. Comparative effectiveness of teriflunomide vs dimethyl fumarate in multiple sclerosis. Neurology (2019).