Editing Multiple sclerosis (section)

==== Progressive multiple sclerosis ====
In 2011, mitoxantrone was the first medication approved for secondary progressive MS.<ref name="BopeKellerman2011">{{cite book | vauthors = Keegan BM | chapter = Multiple Sclerosis | veditors = Bope ET, Kellerman RD |title=Conn's Current Therapy 2012: Expert Consult – Online and Print|chapter-url=https://books.google.com/books?id=pyKjGU5JdqQC&pg=PT662|date=22 December 2011|publisher=Elsevier Health Sciences|isbn=978-1-4557-0738-6|pages=626 }}</ref> In this population, tentative evidence supports mitoxantrone moderately slowing the progression of the disease and decreasing rates of relapses over two years.<ref name="CochMit2013">{{cite journal | vauthors = Martinelli Boneschi F, Vacchi L, Rovaris M, Capra R, Comi G | title = Mitoxantrone for multiple sclerosis | journal = The Cochrane Database of Systematic Reviews | volume = 5 | issue = 5 | pages = CD002127 | date = May 2013 | pmid = 23728638 | doi = 10.1002/14651858.CD002127.pub3 | pmc = 11745300 | hdl = 2434/533488 | hdl-access = free }}</ref><ref>{{cite journal | vauthors = Marriott JJ, Miyasaki JM, Gronseth G, O'Connor PW | title = Evidence Report: The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology | journal = Neurology | volume = 74 | issue = 18 | pages = 1463–70 | date = May 2010 | pmid = 20439849 | pmc = 2871006 | doi = 10.1212/WNL.0b013e3181dc1ae0 }}</ref>

New approved medications continue to emerge. In March 2017, the FDA approved ocrelizumab as a treatment for primary progressive MS in adults, the first drug to gain that approval,<ref name="pmid31598138">{{cite journal | vauthors = Faissner S, Gold R | title = Progressive multiple sclerosis: latest therapeutic developments and future directions | journal = Therapeutic Advances in Neurological Disorders | volume = 12 | pages = 1756286419878323 | year = 2019 | pmid = 31598138 | pmc = 6764045 | doi = 10.1177/1756286419878323 | doi-access = free }}</ref><ref name="STATapproval">{{cite news |title=After 40-year odyssey, first drug for aggressive MS wins FDA approval |url=https://www.statnews.com/2017/03/28/multiple-sclerosis-ms-drug-ocrelizumab/ |date=28 March 2017 | vauthors = Winslow R |publisher=STAT |url-status=live |archive-url=https://web.archive.org/web/20170401151407/https://www.statnews.com/2017/03/28/multiple-sclerosis-ms-drug-ocrelizumab/ |archive-date=1 April 2017 }}</ref><ref name="Ocrevus FDA label">{{cite web | title=Ocrevus- ocrelizumab injection | website=DailyMed | date=13 December 2019 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9da42362-3bb5-4b83-b4bb-b59fd4e55f0d | access-date=26 March 2020 | archive-date=27 June 2020 | archive-url=https://web.archive.org/web/20200627100425/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9da42362-3bb5-4b83-b4bb-b59fd4e55f0d | url-status=live }}</ref> with requirements for several [[Phases of clinical research#Phase IV|Phase IV]] clinical trials.<ref name="FDABLAapproval">{{cite web|title=BLA Approval Letter|url=https://www.accessdata.fda.gov/drugsatfda_docs/appletter/2017/761053Orig1s000ltr.pdf|publisher=FDA|date=28 March 2017|url-status=dead|archive-url=https://web.archive.org/web/20170402081250/https://www.accessdata.fda.gov/drugsatfda_docs/appletter/2017/761053Orig1s000ltr.pdf|archive-date=2 April 2017}}</ref> It is also used for the treatment of relapsing forms of multiple sclerosis, to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease in adults.<ref name="Ocrevus FDA label" /> According to a 2021 [[Cochrane review]], ocrelizumab may reduce worsening of symptoms for primary progressive MS and probably increases unwanted effects but makes little or no difference to the number of serious unwanted effects.<ref>{{cite journal | vauthors = Lin M, Zhang J, Zhang Y, Luo J, Shi S | title = Ocrelizumab for multiple sclerosis | journal = The Cochrane Database of Systematic Reviews | volume = 2022 | issue = 5 | pages = CD013247 | date = May 2022 | pmid = 35583174 | pmc = 9115862 | doi = 10.1002/14651858.CD013247.pub2 | collaboration = Cochrane Multiple Sclerosis and Rare Diseases of the CNS Group }}</ref>

In 2019, [[siponimod]] and [[cladribine]] were approved in the United States for the treatment of secondary progressive multiple sclerosis (SPMS).<ref name="pmid31598138" /> Subsequently, [[ozanimod]] was approved in 2020, and [[ponesimod]] was approved in 2021, which were both approved for management of CIS, relapsing MS, and SPMS in the U.S., and RRMS in Europe.<ref>{{Cite book | vauthors = Penner IK, Schreiber H | chapter = Disease Modifying Immunotherapies and Fatigue | veditors = Penner IK |title=Fatigue in Multiple Sclerosis |publisher=Springer, Cham |year=2023 |isbn=978-3-031-13498-2 | pages = 161–177 }}</ref>

[[Ocrelizumab/hyaluronidase]] was approved for medical use in the United States in September 2024.<ref>{{cite press release | title=FDA Approves Ocrevus Zunovo as the First and Only Twice-A-Year 10-Minute Subcutaneous Injection for People With Relapsing and Progressive Multiple Sclerosis | website=Genentech | date=13 September 2024 | url=https://www.gene.com/media/press-releases/15036/2024-09-13/fda-approves-ocrevus-zunovo-as-the-first | access-date=13 September 2024 | archive-date=14 September 2024 | archive-url=https://web.archive.org/web/20240914061044/https://www.gene.com/media/press-releases/15036/2024-09-13/fda-approves-ocrevus-zunovo-as-the-first | url-status=live }}</ref><ref>{{cite press release | title=Halozyme Announces FDA Approval of Roche's Subcutaneous Ocrevus Zunovo with Enhanze for People with Relapsing and Primary Progressive Multiple Sclerosis | publisher=Halozyme Therapeutics | via=PR Newswire | date=13 September 2024 | url=https://www.prnewswire.com/news-releases/halozyme-announces-fda-approval-of-roches-subcutaneous-ocrevus-zunovo-with-enhanze-for-people-with-relapsing-and-primary-progressive-multiple-sclerosis-302247928.html | access-date=13 September 2024 | archive-date=14 September 2024 | archive-url=https://web.archive.org/web/20240914061013/https://www.prnewswire.com/news-releases/halozyme-announces-fda-approval-of-roches-subcutaneous-ocrevus-zunovo-with-enhanze-for-people-with-relapsing-and-primary-progressive-multiple-sclerosis-302247928.html | url-status=live }}</ref>