Multiple sclerosis disease-modifying therapies
Long-term immune-modulating medicines that reduce relapses and new lesions in multiple sclerosis; several raise the risk of serious infections such as PML.
What they are
Multiple sclerosis is an immune-mediated demyelinating disease of the central nervous system. Disease-modifying therapies do not cure it but lower relapse rates and slow the build-up of lesions. They include injectables (interferon beta, glatiramer acetate), oral agents (S1P receptor modulators such as fingolimod, fumarates such as dimethyl fumarate, teriflunomide, cladribine) and infused or injected monoclonal antibodies (natalizumab, ocrelizumab, ofatumumab, alemtuzumab). Relapses themselves are treated with short courses of high-dose corticosteroids.
Mechanism of action
Each family hits a different step of the immune attack: S1P modulators trap lymphocytes in lymph nodes; natalizumab blocks alpha-4 integrin so lymphocytes cannot cross the blood-brain barrier; anti-CD20 antibodies deplete B cells; teriflunomide blocks pyrimidine synthesis in dividing lymphocytes; fumarates activate the Nrf2 antioxidant pathway; glatiramer acetate shifts T cells toward an anti-inflammatory profile.
Target: Immune targets: S1P receptors, alpha-4 integrin, CD20, dihydroorotate dehydrogenase, Nrf2 pathway
Drugs in this class
- FingolimodAn oral S1P receptor modulator for relapsing multiple sclerosis that keeps lymphocytes in lymph nodes; the first dose…Sphingosine 1-phosphate receptor 1 (S1P1; also S1P3, S1P4, S1P5)
- Glatiramer acetateA random polymer of four amino acids injected under the skin for relapsing multiple sclerosis; it shifts immune cells…MHC class II molecules and myelin-reactive T cells (immunomodulation)
- NatalizumabA monthly infused antibody against alpha-4 integrin that keeps lymphocytes out of the brain; its key risk is PML from…Alpha-4 integrin (α4β1 and α4β7)
- Dimethyl fumarateAn oral fumarate for relapsing multiple sclerosis that activates the Nrf2 antioxidant pathway; flushing and GI upset…KEAP1, the protein that controls the transcription factor Nrf2
- OcrelizumabAn anti-CD20 antibody infused every 6 months that depletes B cells; used in relapsing and primary progressive multiple…CD20 on B lymphocytes
- TeriflunomideAn oral DHODH inhibitor for relapsing multiple sclerosis; it can injure the liver and harm a fetus, and stays in the…Dihydroorotate dehydrogenase (DHODH)
- AlemtuzumabAn anti-CD52 antibody that wipes out circulating lymphocytes for a long time. Given by IV infusion in yearly courses…CD52, a surface protein of lymphocytes
- FampridineA potassium channel blocker that helps some people with multiple sclerosis walk better. It lowers the seizure threshold.Voltage-gated potassium channels (Kv)
- OzanimodAn oral S1P receptor modulator that keeps lymphocytes inside lymph nodes. Used for relapsing MS and ulcerative…Sphingosine-1-phosphate receptor 1 (S1PR1)
- SiponimodAn oral S1P receptor modulator for relapsing and active secondary progressive MS. A CYP2C9 gene test decides whether…Sphingosine-1-phosphate receptor 1 (S1PR1)
Others in the class
- Interferon beta
- Siponimod
- Ozanimod
- Ponesimod
- Diroximel fumarate
- Cladribine
- Ofatumumab
- Alemtuzumab
Test yourself
Think of the answer, then tap the question to see it.
Which MS drug blocks lymphocyte entry into the CNS through alpha-4 integrin?
Natalizumab.
Which infection is the key risk of natalizumab?
Progressive multifocal leukoencephalopathy (PML) from the JC virus.
How does fingolimod reduce MS relapses?
Its phosphate modulates S1P receptors and traps lymphocytes in lymph nodes.
Which enzyme does teriflunomide inhibit?
Dihydroorotate dehydrogenase (de novo pyrimidine synthesis).
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: DailyMed - FINGOLIMOD capsule (DailyMed (U.S. National Library of Medicine), 2026); Natalizumab Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.