A comprehensive review on the treatment approaches of multiple sclerosis: currently and in the future

• Published in: Inflammation research 2019-01, Vol.68 (1), p.25-38
• Main Authors: Gholamzad, Mehrdad, Ebtekar, Masoumeh, Ardestani, Mehdi Shafiee, Azimi, Maryam, Mahmodi, Zeinab, Mousavi, Mohammad Javad, Aslani, Saeed
• Format: Article
• Language: English
• Subjects: Accounting; Adults; Allergology; Animals; Biomedical and Life Sciences; Biomedicine; Bone Marrow Transplantation; Brain damage; Brain injury; Central nervous system; Demyelination; Dermatology; Drugs, Investigational - therapeutic use; Epigenesis, Genetic; Humans; Immunology; Immunomodulation; Immunosuppression; Inflammation; Medical treatment; Mesenchymal Stem Cell Transplantation; Monoclonal antibodies; Multiple sclerosis; Multiple Sclerosis - immunology; Multiple Sclerosis - therapy; Myelin Sheath; Myelination; Neurodegeneration; Neurology; Neuroprotection; Pharmacology/Toxicology; Remission; Review; Rheumatology; T-Lymphocytes; Therapy; Young adults
• ISSN: 1023-3830; 1420-908X
• DOI: 10.1007/s00011-018-1185-0

Background Multiple sclerosis (MS) is a chronic and autoimmune disease of the central nervous system (CNS), mainly characterized by inflammatory demyelination, which manifests as relapses and diffuse damage and brain volume loss, both accounting for neurodegeneration, and therefore, physical disability. MS typically affects young adults and is commonly diagnosed in the early years by acute relapses, which then followed through partial or complete remission period. The clinical course of MS is characterized as four major classifications, including relapsing–remitting (RRMS), primary progressive (PPMS), progressive relapsing (PRMS), and secondary progressive (SPMS). Purpose This review provides comprehensive overview of the current treatments and future innovative approaches in the treatment of MS. Results Currently, there is no definite cure for MS. The treatment of MS has mainly been based on the prescription of immunosuppressive and immune-modulating agents. However, a number of disease-modifying treatments (DMTs) have been designed that reduce the attack rate and delay progression and mainly target inflammation settings in these patients. Although remarkable advancements have occurred in the therapy of MS, the rate of progressive disability and early mortality is still worrisome. Recently, a monoclonal antibody (ocrelizumab) was demonstrated to be beneficial in a clinical trial of primary progressive MS. Furthermore, novel treatment strategies concentrating on the remyelination or neuroprotection are under evaluation. Conclusions In spite of prosperous experiences in MS therapy, the future research, hopefully, will bring substantial improvements in the understanding and approaches of MS therapy.