Immunomodulatory medicines for multiple sclerosis: Progress and prospects

Multiple sclerosis (MS) is a neurodegenerative disease with a major inflammatory component that constitutes the most common progressive and disabling neurological condition in young adults. Current therapies are mainly biological agents (β-interferons, a 4-amino acid peptide, and a monoclonal antibody to a cell adhesion molecule on the blood CNS barrier) that either attenuate the inflammatory response or block the movement of immune cells into the CNS. The market landscape for MS drugs is set to change substantially in the near future with the market leaders coming off patent, which gives permission for the emergence of biosimilars. In addition, new small-molecule immunomodulatory drugs are beginning to enter the market (Gilenya is the first to gain widespread approval), along with a number of immunomodulatory monoclonal antibodies. Both existing and emerging immunomodulatory medicines for MS are reviewed and their impact on the expression and progression of MS (in all its forms) considered, along with the rapidly changing landscape of MS pharmacotherapy. Drug Dev Res 72:664–673, 2011. © 2011 Wiley Periodicals, Inc.