Editing Multiple sclerosis (section)

==== Relapsing-remitting multiple sclerosis ====
Multiple [[Management of multiple sclerosis#Disease-modifying treatments|disease-modifying]] medications were approved by regulatory agencies for RRMS; they are modestly effective at decreasing the number of attacks.<ref name=He2016>{{cite journal | vauthors = He D, Zhang C, Zhao X, Zhang Y, Dai Q, Li Y, Chu L | title = Teriflunomide for multiple sclerosis | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | pages = CD009882 | date = March 2016 | issue = 3 | pmid = 27003123 | doi = 10.1002/14651858.CD009882.pub3 | pmc = 10493042 }}</ref> [[Interferons]]<ref name=Rice2001>{{cite journal |vauthors=Rice GP, Incorvaia B, Munari L, et al. |title=Interferon in relapsing-remitting multiple sclerosis |journal=Cochrane Database Syst Rev |issue=4 |pages=CD002002 |year=2001 |volume=2001 |pmid=11687131 |pmc=7017973 |doi=10.1002/14651858.CD002002 }}</ref> and [[glatiramer acetate]] are first-line treatments<ref name="Tsang20112"/> and are roughly equivalent, reducing relapses by approximately 30%.<ref name=Hassan2011>{{cite journal | vauthors = Hassan-Smith G, Douglas MR | title = Management and prognosis of multiple sclerosis | journal = British Journal of Hospital Medicine | volume = 72 | issue = 11 | pages = M174-6 | date = November 2011 | pmid = 22082979 | doi = 10.12968/hmed.2011.72.Sup11.M174 }}</ref> Early-initiated long-term therapy is safe and improves outcomes.<ref name="pmid21205679">{{cite journal | vauthors = Freedman MS | title = Long-term follow-up of clinical trials of multiple sclerosis therapies | journal = Neurology | volume = 76 | issue = 1 Suppl 1 | pages = S26-34 | date = January 2011 | pmid = 21205679 | doi = 10.1212/WNL.0b013e318205051d | s2cid = 16929304 }}</ref><ref name="pmid22284996">{{cite journal | vauthors = Qizilbash N, Mendez I, Sanchez-de la Rosa R | title = Benefit-risk analysis of glatiramer acetate for relapsing-remitting and clinically isolated syndrome multiple sclerosis | journal = Clinical Therapeutics | volume = 34 | issue = 1 | pages = 159–176.e5 | date = January 2012 | pmid = 22284996 | doi = 10.1016/j.clinthera.2011.12.006 }}</ref>

Treatment of CIS with interferons decreases the chance of progressing to clinical MS.<ref name="pmid1897097722"/><ref name="pmid21205678">{{cite journal | vauthors = Bates D | title = Treatment effects of immunomodulatory therapies at different stages of multiple sclerosis in short-term trials | journal = Neurology | volume = 76 | issue = 1 Suppl 1 | pages = S14-25 | date = January 2011 | pmid = 21205678 | doi = 10.1212/WNL.0b013e3182050388 | s2cid = 362182 }}</ref><ref>{{cite journal |vauthors=Clerico M, Faggiano F, Palace J, et al. |title=Recombinant interferon beta or glatiramer acetate for delaying conversion of the first demyelinating event to multiple sclerosis |journal=Cochrane Database Syst Rev |issue=2 |pages=CD005278 |date=April 2008 |pmid=18425915 |doi=10.1002/14651858.CD005278.pub3}}</ref> Efficacy of interferons and glatiramer acetate in children has been estimated to be roughly equivalent to that of adults.<ref name="pmid22642799">{{cite journal | vauthors = Johnston J, So TY | title = First-line disease-modifying therapies in paediatric multiple sclerosis: a comprehensive overview | journal = Drugs | volume = 72 | issue = 9 | pages = 1195–211 | date = June 2012 | pmid = 22642799 | doi = 10.2165/11634010-000000000-00000 | s2cid = 20323687 }}</ref> The role of some newer agents such as [[fingolimod]],<ref name=LaMantia2016>{{cite journal |vauthors=La Mantia L, Tramacere I, Firwana B, et al. |title=Fingolimod for relapsing-remitting multiple sclerosis |journal=Cochrane Database Syst Rev |volume=2016 |pages=CD009371 |date=April 2016 |issue=4 |pmid=27091121 |doi=10.1002/14651858.CD009371.pub2 |pmc=10401910 }}</ref> [[teriflunomide]], and [[dimethyl fumarate]],<ref name=Xu2015>{{cite journal |vauthors=Xu Z, Zhang F, Sun F, et al. |title=Dimethyl fumarate for multiple sclerosis |journal=Cochrane Database Syst Rev |issue=4 |pages=CD011076 |date=April 2015 |volume=2015 |pmid=25900414 |doi=10.1002/14651858.CD011076.pub2 |pmc=10663978 }}</ref> is not yet entirely clear.<ref name="pmid22014437" /> Making firm conclusions about the best treatment is difficult, especially regarding the long‐term benefit and safety of early treatment, given the lack of studies directly comparing disease-modifying therapies or long-term monitoring of patient outcomes.<ref>{{cite journal |vauthors=Filippini G, Del Giovane C, Clerico M, et al. |title=Treatment with disease-modifying drugs for people with a first clinical attack suggestive of multiple sclerosis |journal=Cochrane Database Syst Rev |volume=2017 |pages=CD012200 |date=April 2017 |issue=4 |pmid=28440858 |pmc=6478290 |doi=10.1002/14651858.CD012200.pub2 }}</ref>

The relative effectiveness of different treatments is unclear, as most have only been compared to placebo or a small number of other therapies.<ref name=Filippini2013>{{cite journal |vauthors=Filippini G, Del Giovane C, Vacchi L, et al. |title=Immunomodulators and immunosuppressants for multiple sclerosis: a network meta-analysis |journal=Cochrane Database Syst Rev |issue=6 |pages=CD008933 |date=June 2013 |pmid=23744561 |doi=10.1002/14651858.CD008933.pub2 |pmc=11627144 }}</ref> Direct comparisons of interferons and glatiramer acetate indicate similar effects or only small differences in effects on relapse rate, disease progression, and MRI measures.<ref>{{cite journal |vauthors=La Mantia L, Di Pietrantonj C, Rovaris M, et al |title=Interferons-beta versus glatiramer acetate for relapsing-remitting multiple sclerosis |journal=Cochrane Database Syst Rev |volume=2016 |pages=CD009333 |date=November 2016 |issue=11 |pmid=27880972 |pmc=6464642 |doi=10.1002/14651858.CD009333.pub3}}</ref> There is high confidence that [[natalizumab]], [[cladribine]], or [[alemtuzumab]] are decreasing relapses over two years for people with RRMS.<ref name="Tramacere2015">{{cite journal |vauthors=Gonzalez-Lorenzo M, Ridley B, Minozzi S, Del Giovane C, Peryer G, Piggott T, Foschi M, Filippini G, Tramacere I, Baldin E, Nonino F |date=January 2024 |title=Immunomodulators and immunosuppressants for relapsing-remitting multiple sclerosis: a network meta-analysis |journal=Cochrane Database Syst Rev |volume= 2024|issue= 1|pages= CD011381|doi=10.1002/14651858.CD011381.pub3 |pmc= 10765473|pmid=38174776 |hdl-access=}}</ref> Natalizumab and [[interferon beta-1a]] ([[Interferon beta-1a#Brand names|Rebif]]) may reduce relapses compared to both placebo and interferon beta-1a (Avonex) while [[Interferon beta-1b]] ([[Interferon beta-1b#Commercial formulations|Betaseron]]), glatiramer acetate, and [[mitoxantrone]] may also prevent relapses.<ref name=Filippini2013 /> Evidence on relative effectiveness in reducing disability progression is unclear.<ref name=Filippini2013 /> There is moderate confidence that a two-year treatment with natalizumab slows disability progression for people with RRMS.<ref name=Tramacere2015 /> All medications are associated with adverse effects that may influence their risk-to-benefit profiles.<ref name=Filippini2013 /><ref name=Tramacere2015 />

[[Ublituximab]] was approved for medical use in the United States in December 2022.<ref>{{cite press release | title=TG Therapeutics Announces FDA Approval of Briumvi (ublituximab-xiiy) | publisher=TG Therapeutics | via=GlobeNewswire | date=28 December 2022 | url=https://www.globenewswire.com/news-release/2022/12/28/2580377/8790/en/TG-Therapeutics-Announces-FDA-Approval-of-BRIUMVI-ublituximab-xiiy.html | access-date=29 December 2022 | archive-date=28 December 2022 | archive-url=https://web.archive.org/web/20221228194153/https://www.globenewswire.com/news-release/2022/12/28/2580377/8790/en/TG-Therapeutics-Announces-FDA-Approval-of-BRIUMVI-ublituximab-xiiy.html | url-status=live }}</ref>