The era of disease-modifying drugs (DMDs) in multiple sclerosis (MS) treatment began in the 1990s, first with interferon-beta (IFNbeta), and the number of agents has increased steadily since then. Currently, there are six different parenteral formulations approved for MS treatment and many other oral and parenteral ones are in different stages of investigation or awaiting approval by federal agencies. All of these medications have demonstrated partial efficacy along with different side effect profiles. Increasing our understanding about the natural behaviour of MS and its different types and stages, diversity of different therapies, their strength and weaknesses, and their serious and sometimes life-threatening side effects have created challenges for treating physicians; making the choice of individualized optimal treatment increasingly more complicated. In this review, we will summarize present and future treatment options and also address clinical challenges we are regularly facing in arriving at treatment choices for our patients.
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