Ultimate Guide To Multiple Sclerosis Treatments And Medications In 2025

Introduction To Multiple Sclerosis And Treatment Options

What Is Multiple Sclerosis (MS): It is a chronic autoimmune condition of the central nervous system (CNS) (i.e., brain and spinal cord). The immune system incorrectly attacks myelin, the protective sheath of nerve fibers, causing nerve damage and inflammation.

Damaged myelin nerve fibers create a barrier to signals from the brain to the rest of the body that produces varying symptoms. While each person's symptoms are entirely different, the most common symptoms of MS are fatigue, difficulty walking, numbness and/or tingling, weakness, vision deficits, and cognitive issues (National Multiple Sclerosis Society [NMSS], 2025).

While the exact causes for MS is still unknown, it is likely due to a combination of genetic and environmental factors. MS has no cure at this time; however, treatment available to assist with symptom management, disease progression, and quality of life.

If you're newly diagnosed, managing relapsing MS, or supporting a loved one, this guide will help you understand the latest treatments and how they can fit into your journey.

Why Treatment Matters: Treatment is key to improving overall health, treating symptoms, and preventing the progression of a variety of conditions. It allows individuals to take their lives back, improve their quality of life, and achieve better long-term outcomes.

Treatment effectively and early can lead to fewer complications, better speed of recovery, and improved emotional and mental well-being.

Treatment during difficult times will help achieve resilience and allow for healthy and meaningful lives.

Understanding Disease-Modifying Therapies (DMTs)

What Are DMTs? Disease-Modifying Therapies (DMTs) aim to reduce relapses, and slow progression of diseases like multiple sclerosis.

DMTs are intended to target specific areas of the immune system in an effort to control inflammation, and reduce the damage that occurs to the nervous system.

One example is ocrelizumab (brand name Ocrevus), a monoclonal antibody specifically targeting B cells which are participating in the disease process. Ocrelizumab reduces relapses and slows disability progression through this mechanism (Hauser et al., 2017).

Another example is natalizumab, which prevents immune cells from crossing the blood-brain barrier to enter the central nervous system and attack the central nervous system.

Such therapies will help to reduce symptoms and support improved quality of life for individuals with long-term, chronic health conditions.

High-Efficacy Vs. Low-Efficacy DMTs: High-Efficacy Therapeutics (HETA), such as alemtuzumab and cladribine, provide excellent disease activity control with dramatically reduced rates of disability progression and relapse rates.

 

Low-Efficacy Therapeutics (LETA), like interferons and glatiramer acetate, have relatively less control in reducing disease activity.

 

HETA may have greater efficacy by decreasing irreversible damage, by providing better disease activity from the outset for patients with aggressive forms of multiple sclerosis.

 

In general HETA will offer better outcomes overall than LETA with stepped therapy; however, safety, clinical characteristics, adverse events, subjectivity, and other situational factors all will have an impact on an individual therapy.

Top DMTs In 2025

Ocrevus (Ocrelizumab): This medication was approved by the FDA for Relapsing-Remitting Multiple Sclerosis (RRMS) and Progressive Primary Multiple Sclerosis (PPMS) and had a 21.6% patient share in 2023.

In clinical trials, Ocrevus significantly slowed relapse rates and disease progression (Hauser et al., 2017), making it the most commonly utilized therapy for people with multiple sclerosis.

Kesimpta (ofatumumab): A B-cell targeting home therapy treating relapsing forms of multiple sclerosis (RMS) which decreases inflammation and disease progression.

Tysabri (natalizumab): Highly effective treatment for aggressive MS. Tysabri works by blocking immune cells from crossing the blood-brain barrier, reducing inflammation and damage to the CNS.

Prescribed mainly for relapsing forms of multiple sclerosis (MS), Tysabri is used in patients who have inadequate treatment response. Patients prescribed Tysabri should be monitored due to the risk of progressive multifocal leukoencephalopathy (PML), a rare but potentially fatal brain infection.

Oral DMTs: An oral DMT such as Fingolimod, teriflunomide, or dimethyl fumarate may sometimes be chosen as it provides convenient administration, or ease of use. These agents are presented as an alternative to injectable agents and may provide a more manageable regimen and treatment efficacy in managing their multiple sclerosis symptoms.

Side Effects And Risks: Disease modifying therapies (DMTs) may be beneficial for managing the progression of certain diseases, but must be considered with their side effect and associated risks. Most common side effects consist of fatigue, nausea, headache, and flu-like symptoms.

Patients may also experience injection site local reactions such as redness, swelling, or irritation if the DMT was administered by injection.

Serious risks may consist of complications from immune suppression, which could render you more prone to infection. Liver damage, cardiovascular problems, and an increased risk of certain cancers are side effects which have been indicated in certain DMTs.

It also cannot be ignored that if the patient may show neurological signs of new side effects such as seizures or changes in cognitive status or mood.

Ultimately, a patient and provider should consider together the benefits and risks of DMTs to make an informed decision on the best course of treatment for the individual based on their condition and past medical history.

Regular follow-up care and monitoring is also important to manage any adverse effects caused from treatment.

Comparison of Common MS Treatments

Medication	Type	Approved For	How It Works	Common Side Effects
Ocrevus (Ocrelizumab)	Infusion	RRMS, PPMS	Targets B-cells to slow relapses and disease progression	Fatigue, infusion reactions
Kesimpta (Ofatumumab)	Self-injection	Relapsing MS (RMS)	B-cell depleting therapy to reduce inflammation	Headache, upper respiratory infections
Tysabri (Natalizumab)	Infusion	RMS (inadequate response to other DMTs)	Prevents immune cells from crossing blood-brain barrier	Risk of PML, fatigue, nausea
Oral DMTs (Fingolimod, Teriflunomide, Dimethyl Fumarate)	Oral	RMS	Modulate immune response; convenient for daily use	Nausea, headache, flu-like symptoms

Choosing A DMT: Choosing a disease-modifying therapy (DMT) entails consideration of multiple components, including efficacy, mode of administration of the DMT (oral or infusion), and how well it fits within a person's daily routine.

The efficacy of DMTs is probably the most important piece of information since an effective DMT provides an effective opportunity to manage a condition. The mode of administration, whether oral, injectable, or infusion may affect patient compliance and convenience.

Furthermore, it is worth considering the nature of the patient's daily schedule, work, and personal lifestyle in ensuring that the chosen therapy is appropriate. Speaking with other individuals that have started DMTs is a great source of additional information and possible insight.

Similar considerations are very valuable also when obtaining information from healthcare professionals involved with your healthcare in deciding DMT options.

Emerging Therapies And Research

Myelin Repair: Clemastine has been a recent focus of attention for its therapeutic potentials concerning improving myelin repair and the future expectations for diseases such as multiple sclerosis.

All studies thus far provide evidence that clemastine has the potential for promoting myelin regeneration, which is the sheath surrounding and protecting our nerve fibers and can be lost in certain neurogenerative diseases (Green et al., 2017).

If clemastine is able to promote repair of myelin, this can ultimately improve nerve function and thereby reduce symptoms for affected patients.

Future research is underway to support the in-depth study of clemastine, the mechanics in how it affects myelin repair, and if this has a function in therapeutically moving clinical treatments forward.

Stem Cell Therapy: Autologous hematopoietic stem cell transplantation as an immune repositioning therapy is an emergent treatment option for autoimmune disorders including multiple sclerosis and systemic sclerosis.

The procedure is associated with the collection of the patient's own stem cells and the process removes the dysfunctional immune system with high-dose chemotherapy with or without radiation and then the collected stem cells are infused to create a healthier immune system.

While there are actually very promising data related to reduction of disease activity, there are intrinsic risks related to the conditioning regimen as well as infection risk making patient selection and follow-up crucial.

BTK Inhibitors: CNS-penetrant inhibitors that are in phase 2/3 trials to limit inflammation, show promise for possible clinical efficacy in neuroinflammatory disorders including Alzheimer's disease, multiple sclerosis, and Parkinson's disease.

CNS-penetrant inhibitors will target a select pathway or pathways within the central nervous system to modulate an immune response and reduce chronic inflammation.

Preliminary data suggest that some have promise efficacy including improved cognitive function and limited disease progression (Reich et al., 2021).

As with any new compound, additional research is warranted and long-term studies are essential to validate the safety profile and therapeutic value. 

Tolerogenic Dendritic Cells: Vitamin D3-treated tolDCs to restore immune tolerance have been shown to down regulate various autoimmune diseases through promoting Treg activity, inhibition of pro-inflammatory cytokine production and improving immune regulatory landscape overall.

Use of tolDCs, and tolDCs with vitamin D3, could generate new therapeutic possibilities in autoimmune diseases such as MS, type 1 diabetes, or RA.

Future studies will be needed to understand greater mechanisms, and to clinically activate the promise of vitamin D3-treated tolDCs to restore immune balance.

EBV-Targeted Therapies: The potential causes of MS vaccines or antivirals is still under investigation. Researchers are considering whether some vaccines or antiviral treatments could induce or aggravate the development of multiple sclerosis (MS) in individuals who may already be genetically inclined to develop MS.

No evidence has made MS even a secondary cause. Studying the relationship between the immune system and the progression of MS is important for the safety and effectiveness of medical treatment in practice.

Clinical Trials: These are studying the efficacy of new treatments and therapies. In these studies researchers are going to evaluate the safety and efficacy of the potential drug as therapy.

Participants also have the potential to receive cutting-edge treatments ahead of the general population. Researchers have the opportunity to collect data that will allow them to try to improve the treatment approaches for managing MS.

Lifestyle And Complementary Approaches

Recommended MS Diet: A balanced diet is essential to managing multiple sclerosis (MS). Not only will it reduce inflammation, but it will also promote brain and nerve health, as well as improve overall energy.

 

Aim to eat a variety of fresh fruits and vegetables - especially greens, such as kale; berries; and carrots. These foods provide antioxidants and essential nutrients. Healthy fats from salmon, flaxseed and walnuts are also important for brain function.

 

Whole grains such as quinoa and oatmeal offer long lasting energy and they also offer some digestive health. Lean proteins, such as chicken, tofu and legumes, are good options to keep muscle strength, while low-fat dairy and plant-based choices will support bone health.

Drinking plenty of water is also important for overall bodily function. Avoid highly processed foods or consuming any unnecessary sugar or trans-fats as this will only increase inflammation and tiredness.

Foods high in vitamin D, such as fortified cereals and some eggs, are also beneficial because many people with MS have low vitamin D levels (NMSS, 2025).

Since symptoms and triggers of MS can differ from person to person, it is a good idea to avoid any dietary triggers you know of (i.e. excess caffeine, alcohol or sodium). 

Ask your healthcare provider or nutritionist to help you create a personalized diet.

Foods To Avoid: People with Multiple Sclerosis (MS) can benefit from not eating certain foods that can worsen symptoms or promote inflammation.

 

Foods with saturated fat (e.g. beef, butter, full-fat dairy), foods with trans fat (e.g. processed snack foods, fried foods, or anything processed) will increase inflammation and otherwise detrimentally effect on health and symptoms.

 

Sugar and refined carbs can lead to energy crashes and weight gain—all of which would make fatigue or other symptoms experienced with MS much worse.

Processed foods, foods with sodium and foods with alcohol, can be detrimental to immune health, medication absorption and symptom management. 

While it's uncommon, some individuals with MS may discover that they are in fact sensitive to gluten or dairy, and cutting those out of their diet could alleviate some inflammation and allow them to feel better. 

Lastly, while some people in general may have too much caffeine, others with MS may find it excessively bothers their bladder, or disrupts their sleep.

Because everybody's experience with MS is different, it is important to have a healthcare provider or registered dietitian help determine any food sensitivities and build a diet plan that serves you best.

Supplements: Certain supplements may help support the immune system, the inflammatory process, and symptom reduction to some degree for those diagnosed with multiple sclerosis (MS). For supplements for people with MS, click here.

 

Vitamin D is arguably the most commonly recommended supplement for MS and is believed to provide some preventive properties against disease progression and support immune regulation. Omega-3 fatty acids (fish oil or flaxseed oil) are often noted for their anti-inflammatory effect and supportive role of brain health.

 

Vitamin B12 strengthens nerve health and increases energy level. Magnesium may relieve the muscle cramping and spasms that are common features of MS.

Other supplements that have potential benefits include probiotics that support gut health and immune regulation; curcumin (turmeric) that has anti-inflammatory and neuroprotective properties; Coenzyme Q10; Alpha-lipoic acid, which may help reduce fatigue; which may be powerful antioxidants which may slow disease progression. 

Biotin has demonstrated improvement of symptoms for progressive forms of MS. Zinc also supports immune repair and function.

As with many supplements, what may be appropriate to use, and to what degree, may depend upon, or be in some way connected to, the degree of dietary management of food choices, so be sure to check with your health care provider before starting new supplements, or even a new diet, to determine appropriateness and safety.

Exercise: The best exercise for those with multiple sclerosis (MS) is the low-impact exercise that matches their physical ability. Stretching and yoga can increase flexibility and challenging balance.

Water aerobics or swimming includes light resistance and is easy to do because the buoyancy of the water protects the joints. Walking – particularly at a good pace – and riding a stationary bike maintain cardiovascular health.

Strength training using light hand weights and resistance bands maintain muscle tone. Pilates increases core strength and stability leading to better posture and balance.

Rowing, Pilates and cold plunges also help. Breathwork can also be really useful.

It is a good idea to consult a healthcare provider or physical therapist before starting an exercise program. This is needed to develop a program tailored to the individual client with MS and to avoid overexertion.

 

However, regularly engaging in moderate physical activity can support mobility, decrease fatigue, and promote overall health for a person with MS.

 

Good Mental Health Practices: It is vital to maintain good mental health if you are living with multiple sclerosis, as MS is often accompanied by emotional challenges along with physical challenges.

Engaging in regular stress and emotions-mindfulness practices—e.g., mindfulness meditation, deep breathing, yoga, etc.—is helpful for lowering anxiety and creating emotional stability.

Not isolating yourself socially or being in contact with friends, family and MS support groups is also a required human component to increasing mood and fighting off isolation. 

Acknowledging your feelings and seeking out therapy or counseling when it feels right is very important. Speaking and working with a therapist or a counselor that is familiar with folks living with chronic illness can assist you develop tools to manage and cope with depression, anxiety or grief that may arise.

Having a routine and setting attainable goals creates structure and control over your day, which can feel powerful while managing a disease.

Gut Microbiome: There are promising studies on probiotics and the gut-brain axis in multiple sclerosis that imply that gut health could be a component in neurological diseases. For supplements, click here.

One hypothesis is that probiotics could alter the immune system, inflammation, and gut barrier function - all considerations that affect multiple sclerosis. The gut-brain axis is defined as a bidirectional communication axis from the gut to the central nervous system (CNS), and due to the impact of gut microbiota on brain health, it is an area of significant research.

Researchers are currently looking into further therapeutic targets in the gut microbiome for new therapies for the symptoms of multiple sclerosis, and also potentially delay the progression of the disease.

How To Choose The Right Treatment Plan

Personalized Medicine: As diagnostic tools and genetic research advance, personalized treatment of multiple sclerosis (MS) is key. MRI scans are certainly foundational in diagnosing and tracking MS through lesions detected in the brain and spinal cord.

 

Because imaging results inform clinicians about treatments and the progression of MS over time, CSF (cerebrospinal fluid) analysis supports diagnostic accuracy through biomarkers (e.g., oligoclonal bands) that signify central nervous system inflammation and specificity to those who might feature beneficial treatment levels.

A critical element to address will be genetic profiling to predict how a patient might respond to medications, which can minimize side effects while maximizing benefit. There are other considerations, namely elements of lifestyle, such as managing stress, physical activity, and proper diets, that should also be included. 

By employing these medical tools together with an understanding of individual preferences and life contexts, the clinician will have engaged the individual in a collaborative development of a highly personalized therapy plan, ultimately committing to enhancing physical and emotional well-being for individuals living with MS.

Working With Your Neurologist: It is important to be open and honest with your neurologist. Be sure to ask direct, specific questions regarding your diagnosis and treatment options.

It is also important to disclose any relevant information about your symptoms, lifestyle, and medical history, as it will allow your neurologist to create a tailored management plan to meet your goals.

Remain open to a partnership. As a collaborative effort is ultimately in your best interest.

Cost And Access: The financial investment and accessibility of disease-modifying therapies (DMTs) for individuals living with multiple sclerosis (MS) can differ substantially on a case-by-case basis due to multiple factors, including the specific therapy prescribed, location geographically, and health insurance coverage.

DMTs are typically pricey, with some therapies costing individuals thousands of dollars monthly. However, private health insurance, Medicare, and Medicaid will generally cover a substantial portion of the cost of DMTs.

For insured individuals, treatment coverage will likely depend on a plan's formulary and/or the therapy being classified as a preferred or non-preferred drug. Patients may still have out of pocket costs in the form of copayment(s), coinsurance, or deductible, which could lead to high out-of-pocket expenditures. 

However, many pharmaceutical companies have patient assistance programs or copay cards that may offset those expenses substantially.

Individuals with Medicare coverage may have to navigate additional nuances. Medicare Part D plans generally include DMTs, however, beneficiaries may still have a high out-of-pocket spend, especially when in the coverage gap (the "donut hole").

Medicare is generally "pay as you go" based meaning an individual out of pocket costs will depend on their for coverage when they enter the coverage gap. Medicaid often has the most comprehensive coverage for DMTs with little cost share, though eligibility varies by state.

As previously mentioned, access to the DMT may be further complicated by prior authorization requirements, step therapy requirements, or other restrictions by insurers.

That’s why it is essential for individuals living with MS to have open lines of communication with their doctor and their insurance representative to make sure that they know all available options, and may tap into potential financial assistance if required.

Managing Relapses In Multiple Sclerosis

A relapse in multiple sclerosis (MS) is the sudden onset or worsening of neurological symptoms that lasts at least 24 hours and stems from new inflammation or reactivated inflammation in the central nervous system. 

Commonly called flare-ups or exacerbations, relapses occur when the immune system inflames myelin (the protective covering of the nerve); this can lead to symptoms such as blurred vision, numbness, weakness, or loss of coordination. 

Relapses are features of relapsing-remitting MS (RRMS) and may be followed by either partial or complete recovery (remission). Relapses are not the same as pseudo-exacerbations, which are temporary worsening of symptoms related to things such as heat, stress, or infection (NMSS, 2025).

Multiple sclerosis (MS) relapses involve sudden or worsening neurological symptoms due to inflammation in the central nervous system. Symptoms vary widely between individuals and relapses, including optic neuritis, balance issues, or severe fatigue.

A relapse may involve a single symptom (from inflammation in one area) or multiple symptoms (from multiple areas). Relapses typically last from a few days to weeks or months.

 

Common Treatments For MS Relapses

Corticosteroids: Either methylprednisolone (IV) or prednisone (oral), to assist with inflammation and help with recovery; common adverse effects are mood changes and glucose excursion.

Plasma Exchange: for severe relapses that have not improved with steroids, removes inflammatory proteins from blood; common adverse effects of plasma exchange include potential for infection and hypotension.

Medications For Individual Symptoms: gabapentin for pain, baclofen for spasticity, amantadine for fatigue.

Therapy Services: physical therapy, occupational therapy, and/or speech therapy to restore function.

Watchful Waiting: There may be mild relapses which require only modified livestyle and monitoring.

DMT: Ocrevus will decrease the future rate of relapses, but is not meant for acute treatment (Hauser et al., 2017).

Important Note: The recommendation for treatment will vary based on the severity of the relapse; not all relapse grades will be treated by pediatricians. Always consult a neurologist before searching for treatment.

If there any other treatment alternatives check ClinicalTrials.gov or ask the NMSS (https://www.nationalmssociety.org).

Medication And Device For Walking Difficulties

Many MS patients find walking a challenge because of their various degree of spasticity, weakness or foot drop. But there are FDA-approved medications and devices to help with these issues.

The potential treatments listed below are those meant to help improve walking ability specifically approved under rules that consider their treatment effect on walking.

Dalfampridine (Ampyra)

Approval Date: Jan. 2010

Type And Dosing: 10 mg oral potassium channel blocker (2x/day)

Mechanism: Its mechanism is to enhance conduction of nerve signals along demyelinated axons allowing for improvement in walking speed.

Efficacy: Approximately one-third of participants in Phase III trials, showed a ~25% improvement in walking speed (Timed 25-Foot Walk). Efficacy also includes improvements in hand dexterity and cognitive function.

Side Effects: Seizures (greater risk with higher doses), dizziness, nausea, urinary tract infections.

Cautions: Dalfampridine does not interact with any of the disease modifying therapies (DMTs), but it is likely used with DMTs. Dalfampridine is often very costly (~$1,267/month).

Portable Neuromodulation Stimulator (PoNS)

Approval: March 2021

Type: Non-invasive device placed on tongue, with neck-worn controller

Mechanism: Delivers mild electrical signals to brain through cranial nerves to induce neuroplasticity promoting improved gait during rehabilitation.

Effectiveness: In clinical studies, those using PoNS improved Dynamic Gait Index (mean score improvement of 7.95 points over 14 weeks) when compared to sham device usage. PoNS used in conjunction with supervised rehabilitation.

Contraindications: Patients with penetrating injuries to the brain, neurodegenerative disorders, oral health issues, chronic infections, unstable hypertension or diabetes, a pacemaker, or have a history of seizures cannot use PoNS.

*Note- PoNS is only approved for short-term use (less than 6 months) in adults ages 22 and older with mild to moderate MS symptoms.

**For online store offering mobility aids and useful tools for people with MS, click here and here.

Patient With Multiple Sclerosis Stories

Case Study 1: Sarah's Journey: Sarah is a 35-year-old teacher who, five years ago, was diagnosed with multiple sclerosis (MS). After a few challenges, she has adjusted and learned ways to cope with her diagnosis.

Currently, Sarah is taking Ocrevus, a disease-modifying drug that has decreased the number of relapses she experienced. Additionally, she is taking vitamin D to boost her immune system, and omega-3 fatty acids since they are generally thought to be good for the brain.

Sarah said that her diet, exercise, and mind-body connection through yoga and medication allow her to manage her physical health and mental/emotional health.

Sarah also thinks managing MS requires a holistic plan, because one needs to use the medications in addition to the healthy habits in one's everyday life in order to maintain physical activity and mental strength.

Case Study 2: Mike's Resilience: Mike is a 42-year-old software engineer who has lived with this diagnosis of multiple sclerosis (MS) for 8 years. Those years have had both emotional high and low points, and he has learned to live with MS fairly well.

Mike is currently on a disease-modifying therapy, Tecfidera, and since he has received the therapy, he believes that his levels of energy and quality of life have improved.

He also takes magnesium to relieve muscle spasms and includes probiotics to maintain his pipeline. Mike believes that staying educated, staying positive, and building a support base are all important for living well with MS. For Mike, the right drug, the right supplements, and love, made a tremendous difference in living well with MS.

Case Study 3: Emma’s Advocacy: Three years ago Emma, a 29-year-old artist, was hit with a diagnosis of MS that knocked her on her heels. Now she shares her experiences through heartfelt conversations about what living with it looks like.

Since she was diagnosed, she has taken Copaxone every day, and while she still has relapses, she has more days that feel steady. She takes turmeric capsules to lower inflammation and B vitamins to support her nerves.

Art therapy has been her safe space; painting has been an outlet for stress, chaos, and feelings, allowing her to use color to calm her thoughts. 

She says it can be a cathartic experience to share a canvas with your thoughts. She encourages others living with MS to find a creative outlet for themselves and a way to tap into support groups or structure so they can also feel some empowerment.

Is There A Cure For MS?

At this time, MS has no cure, but there are several treatments for symptoms, relapses, and the progression of the disease. Treatments include disease-modifying therapies (DMTs) that target the underlying causes of MS, as well as medications for specific symptoms like fatigue, muscle spasms, or pain.

Treatments are not just limited to medications because patients can also use lifestyle changes and rehabilitation and be multidisciplinary in the approaches taken to improve quality of life (NMSS, 2025).

For example, some lifestyle changes include ("eating right," exercising regularly, and managing stress), and rehabilitation therapies include physical therapy (PT) and occupational therapy (OT); the goal is to keep people as mobile and as independent as possible when they have MS.

What Are The Newest MS drugs?

The most current medications and therapies for multiple sclerosis (MS) in 2025 include its disease-modifying therapies (DMTs), remyelination, and targeting progressive forms of MS.

Below is an overview of the most current FDA-approved medications and promising investigational therapies based on available data:

FDA-Approved Medications (Recently)

🧬 1.     Ocrevus Zunovo (ocrelizumab and hyaluronidase-ocsq)

🗓 Approval Date: September 2024

💉 Type: Subcutaneous injection (10 minute administration time)

📌 Indication: Relapsing MS (RMS) and primary-progressive MS (PPMS)

⚙ How it works: Combines the existing Ocrevus antibody with hyaluronidase to enable faster delivery using Halozyme’s Enhanze® technology.
→ Replaces the 2–4 hour IV with a quick injection

📊 Clinical Result: 

• 97% of patients were relapse-free at 48 weeks
• Reduces hospital time by over 90%

⚠ Side Effects:

Infusion reactions, infections, rare risk of PML (brain infection)

🧬 2. Tyruko (natalizumab-sztn)

🗓 Approved: August 2024

💉 Type: Biosimilar to Tysabri (IV infusion)

📌 Used For: Relapsing MS and Crohn’s Disease

⚙ How It Works: Blocks immune cells from crossing into the brain and spinal cord to reduce CNS inflammation

💡 Why It Matters:
First biosimilar for MS—offers a lower-cost alternative to Tysabri

⚠ Side Effects:
Risk of PML, herpes infections, low platelet count, and allergic reactions
(REMS program required for monitoring)

Investigational Drugs in Late-Stage Clinical Trials

🔬 1. Tolebrutinib

📊 Status: Phase III trials completed (HERCULES, GEMINI 1 & 2, PERSEUS)
→ Granted FDA Breakthrough Therapy designation (Dec 2024)

💊 Type: Oral BTK (Bruton’s Tyrosine Kinase) Inhibitor

📌 Indications: RMS, nrSPMS, PPMS

⚙ Mechanism: Reduces B-cell activity and inflammation by inhibiting BTK

🧠 Progress:

• Delayed disability progression in nrSPMS (HERCULES trial)
• PPMS results expected 2025

🔮 Potential: May become the first approved treatment for non-relapsing SPMS

🔬 2. Fenebrutinib

📊 Status: Phase III trials ongoing (FENhance 1 & 2, FENtrepid)
→ Results expected late 2025

💊 Type: Oral BTK inhibitor

📌 Indications: RMS, PPMS

⚙ Mechanism: Targets inflammation and B-cell dysfunction

🧠 Progress:

• 96% relapse-free after 1 year (Phase II)
• 99% reduction in brain lesions

🔮 Potential: High-efficacy option to prevent relapses and disease progression

🔬 3. PIPE-307

📊 Status: Phase II (launched Jan 2025 with 168 participants)

💊 Type: Oral M1R receptor antagonist

⚙ Mechanism: Stimulates oligodendrocyte precursor cells to regenerate myelin

💡 Background: Derived from a component of green mamba snake venom (MT7)

🧠 Progress:

• Proven safe in Phase I
• Promotes remyelination in preclinical models

🔮 Potential: A first-in-class drug focused on myelin repair

🔬 4. Lucid-21-302 (Lucid-MS)

📊 Status: Preparing IND submission; completed Phase I

💊 Type: Oral neuroprotective myelination enhancer

⚙ Mechanism: Boosts myelin restoration without suppressing the immune system

🧠 Progress:

• Myelin reversal shown in animal studies
• Toxicology ongoing before Phase II

🔮 Possibility: A promising non-immunosuppressive therapy in early development

🌟 Other Promising Therapies

🧪 Frexalimab

• Type: Anti-immune modulator
• Status: Phase I/II trials
• Focus: Relapsing MS and non-relapsing SPMS (nrSPMS)
• Goal: Modulate immune responses and slow disease worsening across MS types

🧪 Orelabrutinib

• Type: BTK inhibitor (originally developed as an anti-cancer drug)
• Status: Phase II trial
• Focus: Relapsing MS (RMS)

🧪 Evobrutinib

• Type: Oral BTK inhibitor
• Status: Phase III trial underway (strong Phase II results)
• Focus: RMS
• Note: Shows early promise for reducing inflammation and slowing progression

🧪 Metformin + Clemastine

• Type: Drug combination therapy
• Goal: Promote myelin repair in MS
• Status: Clinical trials in progress
• Note: Clemastine stimulates remyelination; metformin may enhance its effects

🧪 Vidofludimus Calcium

• Type: Immune and antiviral modulator
• Target: Nurr1 protein and Epstein-Barr Virus (EBV)
• Status: Early clinical trials
• Why it matters: EBV has been linked to increased MS risk

🧪 CAR T-Cell Therapy

• Type: Immune reprogramming therapy
• Status: Early trial stage
• Goal: Use patient’s own modified immune cells to treat MS
• Potential: Could become a groundbreaking treatment if proven safe and effective

🧪 Small Molecule Drug (CAMH)

• Target: Glutamate system in the brain
• Progress: Shown effective in animal (mouse) models
• Next step: Entering human clinical trials

🧪 AhR-Modulating Drug + Dimethyl Fumarate

• Goal: Restore immune tolerance via dendritic cell function
• Mechanism: Combines vitamin D3-treated tolDCs with AhR pathway modulation
• Result: Promising efficacy in MS animal models

How Do I Join A Clinical Trial?

There are multiple steps in joining a clinical trial for multiple sclerosis (MS). Our goal is to help you find a research study that is appropriate for you and that you'll be eligible to participate in. Here is a quick guide:

Consult Your Healthcare Team

Talk about your interest with your neurologist, MS nurse, or primary care provider. They can evaluate your MS type (e.g., relapsing-remitting, primary progressive, secondary progressive), health status, and treatment history to suggest suitable trials, and they might even be able to refer you to studies that they might know about (NMSS, 2025).

Understand Clinical Trials

Clinical trials test new treatments, such as medications, non-drug therapies (e.g., exercise programs), or observational studies (e.g., surveys, saliva samples). They vary by phase (I-IV), with early phases (I-II) focusing on safety and later phases (III-IV) on efficacy and long-term effects. Participation is voluntary, and you can withdraw at any time (ClinicalTrials.gov, 2025).

Search For Trials

Search databases to locate MS studies:

• ClinicalTrials.gov: A global database based in the U.S. You can search "Multiple Sclerosis" and filter by location or MS type, or by MS study status (for example, recruiting). It provides contact information for study coordinators.
• MS Society Research Portal (Canada): Promotes non-pharmacological studies that are currently recruiting participants located in Canada.
• CenterWatch: Connects individuals with studies throughout the world.
• Antidote: Connects you with studies based on location, age, gender, and your specific health condition.

Check Eligibility Criteria

Clinical trials have definite inclusion criteria (e.g., age, type of MS, disability degree) and exclusion criteria (e.g., other health conditions, previous treatments). As one example, the trial for tolebrutinib - the PERSEUS trial - includes patients aged 18-55 years old with primary progressive MS with an EDSS of 2.0-6.5. Be sure to review criteria for inclusion on trial listings or with your doctor.

Contact Trial Coordinators

Contact the study team via the contact information on ClinicalTrials.gov or other study-specific platform. For example, you can email TREATMS@jhmi.edu for the TREAT-MS trial at (Johns Hopkins) or ms-cru.neuro@mcgill.ca for the MS trials at McGill.

Ask them about study specifics and risks and benefits, including logistics related to travel and costs to participate in the trial.

Consider Logistics and Risks

Trials may require multiple visits, testing or travel to a study site (for example, ATTACKMS is based in London). Some costs (travel, testing) may not be covered by your insurance plan, so make sure to clarify this with the trial team.

Risks might include unknown side effects (especially in Phase I/II trials). You will also be in a trial without guaranteed benefit. Benefits of participating are access to new treatments and close monitoring.

Join Advocacy Organizations

Organizations such as the National Multiple Sclerosis Society (U.S.), MS Society (UK), or MS Canada provide trial information and support. They may provide you with notification of new trials or connect you with research networks.

Conclusion

Key Takeaways

Disease-Modifying Therapies (DMTs): Recent Disease-Modifying Therapies (DMTs), such as Ocrevus - Zunovo (subcutaneous, 2024) - and Tyruko (2024 biosimilar to Tysabri) reduce relapses and progression in relapsing and progressive forms of MS (Montalban et al., 2024). They target immune activity to effectively protect myelin and nerves.

With innovations such as faster administration methods and biosimilars that are affordable, more patients will have access to DMTs and be relieved of some of the burden of MS.

Symptom Management: In addition to DMTs, MS disease management encompasses therapies such as physical therapy, medications for spasticity, fatigue, and pain (e.g., baclofen for spasticity, amantadine for fatigue), and lifestyle interventions, including moderate exercise and diet modifications that may improve quality of life.

Hope For Future Therapies: With many investigational products already under investigation, multiple novel drugs (tolebrutinib, fenebrutinib [both BTK inhibitors]) show considerable promise for patients with non-relapsing secondary progressive MS and those suffering from relapsing forms of MS.

We expect clinical trial results from these drugs and more in 2025. Remyelination therapies such as PIPE-307 and Lucid-MS are promising to stimulate a repair process that the body is unable to do naturally (Reich et al., 2021). 

Significant advancements in CAR T-cell therapy, as well as a multitude of other exciting drug discoveries, raise hope for the slow down and/or reversal of MS damage through novel therapies.

What To Do Now

Consult With A Neurologist: Collaborate with your care team to assess disease-modifying therapies (DMT) or clinical trials that match the type and needs of your MS.

Research Clinical Trials: Search for clinical trials like FENhance or PERSEUS that you might qualify for on ClinicalTrials.gov or MS advocacy organizations for access to new, promising treatments.

Stay Updated: Find appropriate information sources like the National Multiple Sclerosis Society (NMSS), MS Canada, or MS Society UK to track therapy, trials, and support information.

Resources

ClinicalTrials.gov: Search for MS trials across the world: (https://clinicaltrials.gov).

National Multiple Sclerosis Society (NMSS): Access trial information and patient resources (https://www.nationalmssociety.org).

MS Canada: Research and beyond for Canadians with MS (https://mscanada.ca).

MS journals: Stay informed with journals including the Multiple Sclerosis Journal (https://journals.sagepub.com/home/msj) or Neurology (https://n.neurology.org).

Stay engaged and stay in conversation with your provider and the MS community to purposefully advocate for your treatment journey.

References

• ClinicalTrials.gov. (2025). Multiple sclerosis clinical trials. Retrieved from https://clinicaltrials.gov
• Goodman, A. D., et al. (2009). Sustained-release oral fampridine in multiple sclerosis: A randomized, double-blind trial. The Lancet, 373(9665), 732–738
• Green, A. J., et al. (2017). Clemastine fumarate as a remyelinating therapy for multiple sclerosis. The Lancet, 390(10104), 2481–2489
• Hauser, S. L., et al. (2017). Ocrelizumab versus interferon beta-1a in relapsing multiple sclerosis. New England Journal of Medicine, 376(3), 221–234
• Montalban, X., et al. (2024). Ocrevus Zunovo: Subcutaneous ocrelizumab in MS. Multiple Sclerosis Journal, 30(8), 987–995
• National Multiple Sclerosis Society (NMSS). (2025). MS treatment and management. Retrieved from https://www.nationalmssociety.org
• Reich, D. S., et al. (2021). BTK inhibitors in multiple sclerosis: Tolebrutinib and fenebrutinib trial updates. Lancet Neurology, 20(9), 729–737