Multiple sclerosis: a narrative overview of current pharmacotherapies and emerging treatment prospects

Abstract

Multiple sclerosis (MS) is a chronic autoimmune disease characterized by pathological processes of demyelination, subsequent axonal loss, and neurodegeneration within the central nervous system. Despite the availability of numerous disease-modifying therapies that effectively manage this condition, there is an emerging need to identify novel therapeutic targets, particularly for progressive forms of MS. Based on contemporary insights into disease pathophysiology, ongoing efforts are directed toward developing innovative treatment modalities. Primarily, monoclonal antibodies have been extensively investigated for their efficacy in influencing specific pathological pathways not yet targeted. Emerging approaches emphasizing cellular mechanisms, such as chimeric antigen receptor T cell therapy targeting immunological cells, are attracting increasing interest. The evolving understanding of microglia and the involvement of ferroptotic mechanisms in MS pathogenesis presents further avenues for targeted therapies. Moreover, innovative treatment strategies extend beyond conventional approaches to encompass interventions that target alterations in microbiota composition and dietary modifications. These adjunctive therapies hold promise as complementary methods for the holistic management of MS. This narrative review aims to summarize current therapies and outline potential treatment methods for individuals with MS.

Keywords: Disease-modifying therapy; Multiple sclerosis; New therapies; Treatment strategies; Treatment targets.

Fig. 1

Potential therapeutic targets for novel treatments of MS. The treatment strategies involve depletion of microglia, the resident immune cells of the CNS, administration of OPCs, which show promise as the first remyelinating option in MS, or CAR-T cells targeting patients’ autoreactive immune cells. Moreover, HSCT may replace the overactive immune cells in patients, and MSCs are thought to play a neuroprotective and remyelinating role. Furthermore, interventions involving dietary modifications and alterations in microbiota composition are considered as complementary therapeutic strategies. The figure was created with BioRender.com. Abbreviations CAR-T cells – chimeric antigen receptor T cells, CNS – central nervous system, HSCT – hematopoietic stem cell transplantation, MS – multiple sclerosis, MSCs – mesenchymal stem cells, OPCs – oligodendrocyte progenitor cells