What medication slows the progression of multiple sclerosis?

October 10, 2025 •

5 min read

According to the National Multiple Sclerosis Society, over 20 disease-modifying therapies (DMTs) are approved by the FDA to help treat multiple sclerosis. A wide range of these medications, including injectables, oral pills, and infusions, play a pivotal role in slowing the disease's progression by targeting and regulating the immune system's attack on the central nervous system.

Quick Summary

Disease-modifying therapies (DMTs) are crucial for slowing the progression of multiple sclerosis by targeting immune system activity. Available as injections, oral medications, and infusions, DMTs work to reduce relapses, limit new brain lesions, and delay disability accumulation. Early intervention and selecting the right treatment for your specific type of MS are key to long-term management.

Key Points

Disease-Modifying Therapies (DMTs) are Key: Unlike treatments for acute attacks, DMTs target the underlying immune dysfunction in MS to alter the disease course and slow its progression.
DMTs Work by Modulating the Immune System: Different DMTs employ various mechanisms, such as depleting harmful immune cells, blocking their movement to the CNS, or shifting the immune system's inflammatory balance.
Treatment Choice Depends on MS Type: The most effective DMT depends on the specific form of MS (e.g., RRMS, SPMS, or PPMS), its activity level, and the patient's individual health profile.
Early Intervention is Crucial: Mounting evidence shows that starting a DMT as early as possible after diagnosis can significantly limit disease activity and delay disability accumulation.
Options Include Injectables, Orals, and Infusions: The variety of DMTs available allows for personalized treatment plans, with administration options ranging from self-injections to oral pills and bi-annual infusions.
New Therapies are Emerging: The field of MS research is active, with promising new drug classes like BTK inhibitors and nasal sprays under investigation, particularly for progressive forms of the disease.

The Role of Disease-Modifying Therapies (DMTs) in MS

Unlike medications used to manage acute relapses, such as corticosteroids, disease-modifying therapies (DMTs) target the underlying immune system dysfunction in multiple sclerosis (MS). By interfering with the abnormal immune response that damages the myelin sheath protecting nerve fibers, DMTs can alter the long-term course of the disease. Starting a DMT early in the disease course has been shown to significantly limit new MS activity and slow the accumulation of disability. The specific medication recommended depends on the type of MS, its activity level, and the individual's overall health and preferences.

How DMTs Address MS Progression

DMTs employ several mechanisms to slow disease progression. They work by:

Reducing immune cell populations: Some therapies, such as anti-CD20 monoclonal antibodies, deplete specific B-cell populations that contribute to MS inflammation.
Preventing immune cell trafficking: Certain drugs block the movement of immune cells from the bloodstream into the brain and spinal cord, reducing inflammation in the central nervous system (CNS).
Modulating the immune response: Older immunomodulators, like interferons and glatiramer acetate, shift the immune system's balance away from the damaging, pro-inflammatory response.
Inhibiting proliferation: Other agents prevent the overgrowth of the immune cells responsible for the autoimmune attack.

Types of Disease-Modifying Therapies

DMTs are available in various forms, offering options tailored to patient needs and disease activity. These include:

Injectable Therapies: These were among the first DMTs approved. Examples include interferons (e.g., Avonex, Rebif, Betaseron) and glatiramer acetate (Copaxone, Glatopa). They are administered via self-injection under the skin or into a muscle on a regular schedule, from daily to weekly.
Oral Medications: This class of treatments offers the convenience of a pill. Oral options include fingolimod (Gilenya), siponimod (Mayzent), dimethyl fumarate (Tecfidera), and cladribine (Mavenclad), among others.
Infused Treatments: Administered intravenously by a healthcare professional at a clinic, these therapies are often highly effective but may be reserved for more active or progressive forms of MS due to their potency. Examples are natalizumab (Tysabri), ocrelizumab (Ocrevus), and alemtuzumab (Lemtrada).

Comparison of Key DMTs for Multiple Sclerosis


Medication (Brand)	Type	Frequency	Approved For	Administration	Notes
Ocrelizumab (Ocrevus)	Infusion (Monoclonal Antibody)	Every 6 months	RRMS, PPMS, SPMS	IV Infusion	First and only FDA-approved drug for PPMS.
Siponimod (Mayzent)	Oral (S1P Receptor Modulator)	Once daily	RRMS, SPMS with active disease	Pill	Requires genetic testing before use.
Natalizumab (Tysabri)	Infusion (Monoclonal Antibody)	Every 4 weeks	RRMS, Active SPMS	IV Infusion	High efficacy but carries a risk of PML.
Fingolimod (Gilenya)	Oral (S1P Receptor Modulator)	Once daily	RRMS, Active SPMS	Pill	May cause heart rate slowing; requires first-dose monitoring.
Cladribine (Mavenclad)	Oral (Purine Antimetabolite)	In cycles over 2 years	RRMS, Active SPMS	Pill	Reserved for aggressive or highly active cases due to safety profile.
Dimethyl Fumarate (Tecfidera)	Oral (Nrf2 Pathway Activator)	Twice daily	RRMS, Active SPMS	Pill	Common side effects include flushing and GI issues.

Spotlight on Ocrelizumab and Siponimod

Ocrelizumab (Ocrevus)

Ocrelizumab is a humanized monoclonal antibody that targets CD20-positive B-cells, a type of immune cell linked to nerve damage in MS. It was the first and, for a time, only FDA-approved treatment for primary progressive multiple sclerosis (PPMS), a form characterized by a steady worsening of symptoms from the onset. Clinical trials have demonstrated its effectiveness in slowing disability progression in both PPMS and relapsing forms of MS. The convenience of receiving an infusion only twice a year can also improve adherence for many patients.

Siponimod (Mayzent)

Siponimod is an oral medication specifically approved for treating adults with relapsing forms of MS and active secondary progressive MS (SPMS). SPMS often follows an initial relapsing-remitting course and involves a gradual, steady worsening of disability. Siponimod works by modulating sphingosine 1-phosphate (S1P) receptors, which traps specific immune cells in the lymph nodes and prevents them from entering the CNS. Clinical trials showed it reduced relapse rates and slowed disability progression in people with active SPMS.

The Promise of Emerging Therapies

The field of MS treatment is constantly evolving, with new drug classes offering hope for patients with both relapsing and progressive forms of the disease. Bruton's tyrosine kinase (BTK) inhibitors are a promising class currently in clinical trials. They are being investigated for their ability to alter the function of B-cells and other immune cells within the CNS, potentially offering a new approach for treating progressive MS. Another recent development is the intranasal spray foralumab, a monoclonal antibody that has shown potential in early trials for reducing neuroinflammation. Research continues to explore these and other avenues, including stem cell transplantation, to find better ways to protect nerves and 'reset' the immune system.

Important Considerations for MS Treatment

Beyond medication, managing MS involves a holistic approach. Lifestyle adjustments and other treatments can significantly impact a person's quality of life and potentially influence disease course. Some important considerations include:

Early Treatment: Starting a DMT as soon as possible after diagnosis is one of the most effective strategies for preventing long-term disability.
Shared Decision-Making: Choosing the right DMT involves weighing a medication's efficacy, side effects, and administration method with your healthcare provider.
Managing Side Effects: All DMTs have potential side effects, from flu-like symptoms with interferons to injection site reactions or more serious complications with stronger immunotherapies. Side effects should be monitored and managed with your care team.
Monitoring Adherence: Staying consistent with your treatment schedule is crucial for its success. Patient education and choosing a therapy that fits your lifestyle are key to improving adherence.
Healthy Lifestyle: A balanced diet, regular exercise, stress management, and avoiding smoking can all complement medical therapy and contribute to better outcomes.

Conclusion

For those living with multiple sclerosis, the question of what medication slows the progression of multiple sclerosis is central to their long-term health. While there is no cure, the arsenal of available DMTs provides powerful tools for managing the disease. From traditional injectables like interferons to modern infused therapies like Ocrevus, these medications target the immune system to reduce relapses, limit nerve damage, and slow the accumulation of disability. With new therapies continuously emerging from research, the future of MS treatment offers increasing hope. It is critical for individuals with MS to partner with their healthcare team to choose the most appropriate DMT, start treatment early, and remain consistent to achieve the best possible outcomes in slowing the disease's advancement. For more information, the National Multiple Sclerosis Society is an excellent resource.

Frequently Asked Questions

A disease-modifying therapy (DMT) is a long-term medication that alters the course of MS by targeting the immune system to reduce inflammation and slow disability progression. In contrast, medications for a relapse, such as corticosteroids, are used short-term to reduce the inflammation and severity of an acute flare-up but do not impact the overall disease course.

Most DMTs are approved for relapsing forms of MS, including relapsing-remitting MS (RRMS) and active secondary-progressive MS (SPMS). A limited number of drugs, most notably ocrelizumab, are also approved for primary-progressive MS (PPMS), representing a significant step forward in treating that form of the disease.

Common side effects vary widely depending on the medication but can include flu-like symptoms, injection site reactions, flushing, and gastrointestinal issues. More potent immunotherapies carry a higher risk of serious side effects, such as infections, which requires careful monitoring.

The decision is a shared process between a patient and their neurologist, taking into account the patient's specific type and activity level of MS, risk tolerance for side effects, lifestyle preferences, and convenience of administration.

Ongoing research is focused on developing new medications, including Bruton's tyrosine kinase (BTK) inhibitors that modulate the immune system within the CNS and intranasal sprays like foralumab that reduce neuroinflammation. Stem cell transplantation is also being explored as a potential 'reset' for the immune system.

The duration of DMT treatment is often long-term and potentially lifelong. Treatment should be continued as long as the medication remains effective and side effects are manageable. Discontinuation is typically not recommended unless a serious adverse event occurs or the patient has confirmed progressive MS without inflammatory activity.

Yes, maintaining a healthy lifestyle is an important complement to medical treatment. Regular exercise, a balanced diet rich in omega-3 fatty acids, managing stress, and quitting smoking have all been shown to positively impact MS symptoms and progression.