title: Update on disease-modifying treatments for multiple sclerosis.
abstract: OBJECTIVE
  The purpose of this review is to discuss the selection and use of disease- modifying treatments for patients with relapsing forms of multiple sclerosis (MS).
  
  
  METHODS
  PubMed was searched (1966-2014) using the terms multiple sclerosis, treatment, interferon, glatiramer acetate, dimethyl fumarate, fingolimod, teriflunomide, natalizumab, rituximab, and alemtuzumab.
  
  
  RESULTS
  MS is a chronic neurological disorder that can cause a substantial degree of disability. Because of its usual onset in young adults, patients may require treatment for several decades. Currently available agents include platform injectable therapies, newer oral agents, and second-line monoclonal antibody treatments. Treatment decisions have become more complex with the introduction of new approaches, and a major goal is to balance perceived efficacy and tolerability in a specific patient with the relative impact of disease activity and adverse events on quality of life. Here the options for disease-modifying treatments for relapsing forms of MS are reviewed, and current and future challenges are discussed.
  
  
  CONCLUSIONS
  An evidence-based approach can be used for the selection of disease-modifying treatments based on disease phenotype and severity, adverse events, and perceived efficacy.
authors.affiliation: Neurology Service, William S. Middleton Memorial Veterans Hospital, Departments of Neurology and Pathology and Program in Cellular and Molecular Pathology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. Electronic address: carrithers@neurology.wisc.edu.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Carrithers
mesh_terms: D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D003437:Crotonates / Q000627:therapeutic use; D000069462:Dimethyl Fumarate; D000068876:Fingolimod Hydrochloride / Q000627:therapeutic use; D000068717:Glatiramer Acetate / Q000627:therapeutic use; D006801:Humans; D006885:Hydroxybutyrates; D007155:Immunologic Factors / Q000627:therapeutic use*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy*; D000069442:Natalizumab / Q000627:therapeutic use; D009570:Nitriles; D011788:Quality of Life; D000069283:Rituximab / Q000627:therapeutic use; D014052:Toluidines / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D003437:Crotonates; D006885:Hydroxybutyrates; D007155:Immunologic Factors; D000069442:Natalizumab; D009570:Nitriles; D014052:Toluidines; C527525:teriflunomide; D000074323:Alemtuzumab; D000069283:Rituximab; D000068717:Glatiramer Acetate; D000069462:Dimethyl Fumarate; D000068876:Fingolimod Hydrochloride
keywords: fumarate; glatiramer; immune therapy; interferon; multiple sclerosis; natalizumab