Multiple sclerosis (MS), an incurable but manageable disorder, is characterized by chronic inflammatory demyelination and neurodegeneration in the central nervous system. Although the primary cause of this often devastating disease remains elusive, major therapeutic advances have occurred during the past two decades. Here, we present a review of current immunomodulatory treatments and outline upcoming therapy approaches, including biologics and oral alternatives that might have equivalent or superior efficacy and/or enhanced tolerability compared with available treatments, and discuss the scientific rationale and expected benefits and risks for these compounds. We also speculate about alternatives beyond immune-directed approaches, review novel insights into the neurobiological consequences of sustained brain inflammation and evaluate future perspectives for neuroprotective and neuroregenerative treatment strategies for MS.
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