Abstract

The treatment of progressive multiple sclerosis (MS) is probably one of the greatest challenges facing the MS community. The need is great for this most disabling form of MS but the challenges are considerable, not least the poor understanding of the mechanisms underpinning progression which in turn creates problems in defining the clinical phenotype and, more importantly, identifying potential targets for effective treatment.

The recent licensing of two agents one for primary (ocrelizumab) and one for secondary progressive MS (siponimod) has gone some way to offset the preceding negative results of trials of agents such as natalizumab and fingolimod. The treatment effect is modest for both (21-25%), perhaps implicating their particular modes of action. The armamentarium has been increased in the USA by the FDA’s ruling that agents that are effective in relapsing forms of MS should also be applied to patients with active (continuing to have relapses) secondary progressive MS

The importance of targeting neuroprotection and repair cannot be over-estimated and results of studies in these areas have been mixed to date. Nonetheless, some progress is being made and with the concerted efforts of organisations such as the Progressive MS Alliance, it is hoped that over the next five years we will have even more effective treatments for progressive MS.