Management of progressive multiple sclerosis (MS) is one of the main challenges 
of the new century. Based on our knowledge of pathophysiology, three therapeutic 
strategies are proposed: anti-inflammatory (ocrelizumab, siponimod…); 
remyelinating (opicinumab); and neuroprotective (high-dose biotin, ibudilast, 
simvastatin…). Nevertheless, despite recent promising positive clinical trials, 
new methodological approaches for therapeutic protocols with adaptable outcomes 
to assess progression are still needed.