Pharmacology of Multiple Sclerosis Current Therapies and Emerging Trends

Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system that leads to inflammation, demyelination, and progressive neurodegeneration. It is a major cause of disability among young adults, especially women, and is associated with a wide range of clinical symptoms, including optic neuritis, sensory and motor deficits, fatigue, bladder dysfunction, and cognitive impairment. The etiology of MS is multifactorial, with genetic predisposition such as HLADRB1*15:01, and environmental factors like Epstein–Barr virus infection, vitamin D deficiency, obesity, and smoking playing important roles in disease onset and progression.The pathophysiology involves an abnormal immune response in which autoreactive T cells and B cells cross the blood– brain barrier, triggering neuroinflammation, myelin loss, and axonal injury. Over time, chronic activation of microglia and mitochondrial dysfunction further contribute to neuronal degeneration and permanent disability. This understanding has driven the development of disease-modifying therapies (DMTs), which aim to reduce relapses, delay progression, and improve quality of life. Traditional injectable agents such as interferons and glatiramer acetate have been widely used, while newer oral drugs, including fingolimod, dimethyl fumarate, and cladribine, as well as monoclonal antibodies like ocrelizumab and natalizumab, provide enhanced efficacy.Recent research focuses on emerging strategies such as remyelination therapies, Bruton's tyrosine kinase inhibitors, stem cell transplantation, and microbiome modulation. Although no curative treatment exists, advances in pharmacology and personalized medicine continue to transform MS management, offering new hope for patients worldwide