Disease‐modifying treatments for multiple sclerosis – a review of approved medications

<jats:sec><jats:title>Background and purpose</jats:title><jats:p>There is still no curative treatment for multiple sclerosis (<jats:styled-content style="fixed-case">MS</jats:styled-content>), but during the last 20 years eight different disease‐modifying compounds have been approved for relapsing−remitting <jats:styled-content style="fixed-case">MS</jats:styled-content> (<jats:styled-content style="fixed-case">RRMS</jats:styled-content>).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A literature search was conducted on published randomized controlled phase III trials indexed in PubMed on the approved medications until 21 May 2015.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In this review the mode of action, documented treatment effects and side effects of the approved <jats:styled-content style="fixed-case">MS</jats:styled-content> therapies are briefly discussed.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Based on current knowledge of risk−benefit of the approved <jats:styled-content style="fixed-case">MS</jats:styled-content> medications, including factors influencing adherence, it is suggested that oral treatment with dimethyl fumarate or teriflunomide should be preferred as a starting therapy amongst the first‐line preparations for <jats:italic>de novo </jats:italic><jats:styled-content style="fixed-case">RRMS</jats:styled-content>. In the case of breakthrough disease on first‐line therapy, or rapidly evolving severe <jats:styled-content style="fixed-case">RRMS</jats:styled-content>, second‐line therapy with natalizumab, fingolimod or alemtuzumab should be chosen based on careful risk−benefit stratification.</jats:p></jats:sec>