Purpose of review: Many therapeutic advances for relapsing-remitting multiple sclerosis (MS) have occurred in the past 25 years. Although similar advances in disease-modifying therapies have not been realized in progressive MS, many symptomatic therapeutic strategies can benefit patients with progressive MS. Few guidelines exist for management of patients with progressive MS.
Recent findings: The classification of progressive MS was revised in 2013 to include a description of inflammatory disease activity determined by clinical relapses or imaging findings. Developing knowledge about the pathogenesis of progressive MS and the role of comorbidities in modifying the disease course has implications for the clinical management of patients with progressive MS as well as for clinical trial design. Current and upcoming clinical trials will assess a wide range of interventions, including immunomodulatory agents, putative neuroprotective molecules, stem cell therapy, nutrition, and rehabilitation techniques.
Summary: None of the therapies currently approved for use in relapsing-remitting MS have been shown to slow the gradual progression of disability that occurs in the absence of recent relapses or changes in MRI. A multidisciplinary approach is needed to address the many symptoms that impact quality of life for patients with progressive MS.