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Table 1 Development timeline for disease-modifying therapy in MS

From: Detecting neurodegenerative pathology in multiple sclerosis before irreversible brain tissue loss sets in

FDA or EMA approval^ProductMain immunological mechanism of action
1993/1996INF β-1b/-1aInduces changes in cytokine balance
1996Glatiramere acetateInterferes with antigen presentation to T-lymphocytes
2000MitoxantroneReduces the number of circulating leukocytes
2004NatalizumabBlocks leukocyte migration across the BBB
2010FingolimodPrevents lymphocyte egression from the lymph nodes
2012TeriflunomideInhibits lymphocyte proliferation
2013Dimethyl fumarateInduces changes in cytokine balance
2014Alemtuzumab
Pegylated INF β-1a
Destructs circulating lymphocytes, followed by repopulation
Induces changes in cytokine balance
2016°DaclizumabInduces immune tolerance
2017Cladribine*
Ocrelizumab
Reduces the number of circulating lymphocytes
Depletes B-lymphocyte population
2019SiponimodPrevents lymphocyte egression from the lymph nodes
PipelineOzanimod and ponesimod
Ofatumumab
Evobrutinib
AHSCT
Prevents lymphocyte egression from the lymph nodes
Depletes circulating B-lymphocytes
Inhibits B-lymphocyte signaling and maturation
Immune system reconstitution
  1. FDA Food and Drug Administration, EMA European Medical Agency, INF interferon, BBB blood-brain barrier, AHSCT autologous stem cell transplantation, MS multiple sclerosis.
  2. ^ based on which approval came first
  3. * No FDA approval at present
  4. ° Withdrawn in 2018