Multiple sclerosis (Multiple Sclerosis, MS) is a chronic autoimmune disease characterized primarily by inflammatory demyelination of the central nervous system. Its clinical course is often marked by alternating relapses and remissions, with some patients gradually progressing to irreversible neurological dysfunction.
Modern treatment concepts emphasize early intervention, disease modification, and neuroprotection in parallel. Today’s therapeutic landscape has evolved into a multi-layered system encompassing immunomodulation, neuroprotection, and symptomatic management. It includes oral agents, injectable therapies, and biologics, offering individualized treatment pathways for patients with different disease phenotypes. Hong Kong DengyueMed provides an in-depth overview of these therapies, whose mechanisms of action differ in focus and together address the needs of diverse patient populations and disease stages.
Immunomodulatory Therapies
Teriflunomide Tablets
As a pyrimidine synthesis inhibitor, teriflunomide reduces the proliferation of activated lymphocytes by inhibiting dihydroorotate dehydrogenase, thereby attenuating immune-mediated attacks within the central nervous system. It is indicated for patients with relapsing-remitting multiple sclerosis (RRMS). Clinical studies have shown that it can reduce the annualized relapse rate by approximately 30%. Liver function should be monitored regularly during treatment, with attention to adverse effects such as elevated liver enzymes and alopecia. It is contraindicated in patients with severe hepatic impairment.
Fingolimod Capsules
Fingolimod is the first oral sphingosine-1-phosphate (S1P) receptor modulator. It sequesters peripheral lymphocytes within lymph nodes, reducing their migration into the central nervous system and thereby decreasing inflammatory infiltration. It is approved for patients aged 10 years and older with relapsing-remitting MS. Electrocardiographic monitoring is required at first dose due to the risk of bradycardia and atrioventricular block. The risk of macular edema should also be considered, and ophthalmologic examinations are recommended before and during treatment.
Siponimod Tablets
Siponimod selectively targets S1P receptor subtypes 1 and 5. In addition to reducing central nervous system inflammation, it may exert a protective effect on oligodendrocytes. It has demonstrated efficacy in delaying disability progression in patients with active secondary progressive multiple sclerosis (aSPMS), making it an important treatment option for this subtype. Monitoring of liver function, blood pressure, and retinal changes is required. Genotyping is recommended prior to initiation to assess metabolic risk.
Ozanimod
A next-generation selective S1P receptor modulator, ozanimod has high affinity for S1P1 and S1P5 receptors, combining immunomodulatory effects with potential neuroprotective benefits. Phase III clinical trials have shown significant reductions in annualized relapse rates, brain atrophy rates, and the number of new MRI lesions. It is indicated for adults with relapsing forms of multiple sclerosis. While generally well tolerated, monitoring for elevated liver enzymes, infection risk, and cardiovascular effects remains necessary.
Ofatumumab Injection
Ofatumumab is a fully human anti-CD20 monoclonal antibody that efficiently depletes peripheral B cells, interrupting their antigen presentation and pro-inflammatory activity within the central nervous system. As one of the most effective biologic therapies currently available for MS, it significantly reduces disease activity. Its subcutaneous administration is convenient and does not rely on hepatic or renal metabolism, making it suitable for patients with impaired liver or kidney function. Infusion-related reactions and infection risk should be monitored, and screening for hepatitis B and JC virus is recommended prior to treatment.
Neuroprotective and Antioxidant Therapies
Dimethyl Fumarate Enteric-Coated Capsules
By activating the nuclear factor erythroid 2–related factor 2 (Nrf2) pathway, dimethyl fumarate enhances cellular resistance to oxidative stress while suppressing neuroinflammation. It is indicated for relapsing-remitting MS and can reduce both annualized relapse rates and MRI lesion burden. Common adverse effects include flushing and gastrointestinal discomfort; enteric-coated formulations help improve tolerability.
Glatiramer Acetate
Glatiramer acetate is a synthetic polypeptide mixture composed of four amino acids that mimics the structure of myelin basic protein. It induces regulatory T cells and promotes immune tolerance, thereby suppressing autoimmune responses. It is suitable for patients with multiple sclerosis and is administered via daily or alternate-day subcutaneous injection. Avoidance of spicy foods may help reduce local allergic reactions. Long-term use has demonstrated a favorable safety profile.
Other Therapeutic Options
Mitoxantrone
Mitoxantrone is an anthracycline chemotherapeutic agent that exerts immunosuppressive effects by inhibiting topoisomerase II and scavenging free radicals. It has been used in patients with highly active or progressive MS. Due to its cardiotoxicity and cumulative dose limitations, it is now primarily reserved as a second-line or rescue therapy. Strict monitoring of cumulative dose (typically not exceeding 140 mg/m²) and regular cardiac function assessments are required.
Treatment Strategies and Patient Management
Treatment decisions should be based on a comprehensive assessment of disease phenotype (e.g., RRMS, SPMS, PPMS), disease activity (clinical relapse frequency and MRI lesion burden), rate of disability progression, and individual patient factors such as age, reproductive plans, and comorbidities. For example, ofatumumab may be preferable for patients with hepatic or renal dysfunction due to its metabolism-independent profile, whereas teriflunomide offers oral convenience but requires regular liver function monitoring.
Importance of Comprehensive Management
Pharmacological treatment should be integrated with non-pharmacological interventions, including physical rehabilitation to maintain motor function, vitamin D supplementation to modulate immune responses, and psychological support to address comorbid depression and anxiety. Regular neurological evaluations and MRI follow-up are essential, and strict adherence to neurologist-guided care is necessary to achieve a “treat-to-target” strategy.
Future Outlook
As understanding of the pathophysiology of multiple sclerosis continues to deepen, new therapies targeting B cells, the S1P pathway, and neural repair mechanisms are rapidly emerging. Future treatment approaches will become increasingly precise and individualized. The dual mechanism exemplified by ozanimod—addressing both physical function and cognitive protection—signals a shift from mere disease control toward functional preservation. In addition, biomarker-guided treatment decisions, remote monitoring, and digital health management are expected to play growing roles in improving patient quality of life.
Through an efficient global supply chain network, DengyueMed ensures the stable availability of key therapies such as teriflunomide and fingolimod, connecting multinational pharmaceutical companies with end markets, optimizing logistics and inventory management, and significantly improving access to essential medications.
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