Multiple sclerosis (MS) is a chronic demyelinating disease of the central 
nervous system (CNS). The modern treatment era for MS witnessed a growing pool 
of drugs now available for use in clinical practice. These therapies work at 
different levels, however there is a lack of treatments acting on the 
neurodegenerative component or improving mechanism of repair. Areas covered: The 
latest knowledge about the pathophysiological changes occurring in MS have 
translated into novel treatments at different stages of development. Drugs for 
MS work mainly through modulating the inflammatory factors of the disease, but 
enhancing remyelination may be more successful in reducing long-term disability. 
Anti-LINGO-1 (opicinumab) is the first investigational product that achieved 
phase I trial with the aim of remyelination and axonal protection and/or repair 
in MS. Expert commentary: Over the past decade considerable strength has been 
applied to find more reliable strategies to improve myelin repair. The 
anti-LINGO-1 trial showed that the drug is safe and tolerable. A future phase II 
trial will provide more insights regarding the compound. The greatest challenge 
for myelin repair therapies will be how to monitor their efficacy. Eventually 
research will need to focus on consistent tools to assess the grade of 
remyelination in vivo.