PURPOSE OF REVIEW: To critically assess the current landscape of 
disease-modifying agents for multiple sclerosis (MS). Treatment algorithms will 
be discussed and studies for new agents in late development or recently approved 
are analyzed in terms of their impact on current treatment strategies.
RECENT FINDINGS: A real-world study from Wales suggests that early initiation of 
highly effective therapy may provide more benefit that an escalation approach in 
relapsing MS. A study from the MSBase dataset found evidence that early 
treatment with highly effective therapies decreased the risk of developing 
secondary progressive MS. Ocrelizumab is highly efficacious in relapsing MS and 
in a group of patients with primary progressive MS. Another CD20 directed mAb, 
ofatumumab, is in phase 3. A large study examining extended interval dosing of 
natalizumab in an attempt to decrease the risk of developing progressive 
multifocal leukoencephalopathy is underway. Cladribine and alemtuzumab may work 
by immune reconstitution. Siponimod was recently approved by United States 
Federal Drug Administration for relapsing MS and active secondary progressive 
MS. Other S1P receptor modulators are being studied in phase 3 trials for 
relapsing MS. Cladribine received FDA approval as treatment for relapsing and 
active secondary progressive MS. Autologous hematopoetic stem-cell 
transplantation may be an option for treatment-refractory MS.
SUMMARY: Development of disease-modifying agents in MS continues to be 
successful. Treatment algorithms need to take new developments into account.