BACKGROUND: Multiple sclerosis (MS) is the most common cause of nontraumatic 
neurological disability in young adults. There is great need for developing 
effective treatments to arrest the disease. As of today, there is no cure for MS 
but several agents mitigating its effects are available. The era of 
disease-modifying therapy began with the use of interferon beta and glatiramer 
acetate in the 1990s. Given the injectable nature and the limited efficacy of 
these agents, efforts are ongoing to develop new treatments.
SUMMARY OF REVIEW: We provide an overview of the ongoing developments in MS 
therapy. After considering the clinical features and measures of drug efficacy 
in MS clinical trials, we report the phase-III clinical trials results of: (1) 3 
oral agents approved within the last 5 years, fingolimod (Gilenya), 
dimethylfumarate (Tecfidera), and teriflunomide (Aubagio); (2) the oral agent 
laquinimod; and (3) the monoclonal antibodies daclizumab, ocrelizumab, and 
alemtuzumab. We will then briefly mention remyelinating and neuroprotective 
agents that are in very early studies. We will end with a possible approach to 
different clinical scenarios to guide the choice of disease-modifying therapy in 
patients.
CONCLUSIONS: The newer agents offer the convenience of oral administration (for 
the oral agents) and potentially higher efficacy, but their long-term safety 
profile remains unknown. All available agents attack only 1 aspect of MS, that 
is, inflammatory demyelination. Arresting or reversing the progression of 
disability will be feasible only with agents affecting remyelination and 
neuroprotection, still in relatively early research.