Emerging Therapies in Multiple Sclerosis Management – Can We Stop the Demyelinating Process?

Abstract

Introduction. Multiple sclerosis (MS) is a chronic autoimmune disorder of the central nervous system (CNS) characterised by neuroinflammation and neurodegeneration leading to progressive disability. Its complex immunopathogenesis involves autoreactive T cells, B cells, and myeloid cells, with growing evidence highlighting the pivotal role of B lymphocytes. B cells contribute through antigen presentation, cytokine secretion, autoantibody production, and formation of ectopic lymphoid structures, making them key therapeutic targets. Current disease-modifying therapies (DMTs), including anti-CD20 monoclonal antibodies such as ocrelizumab, ofatumumab, and recently launched ublituximab, have significantly improved clinical outcomes. However, optimisation of long-term efficacy and safety remains challenging. The novel agent, frexalimab, which targets the CD40–CD40L pathway, aims to refine treatment precision and safety further.Material and methods. A systematic search of PubMed, Scopus, and Web of Science (October–November 2025) was conducted to identify clinical trials and high-quality reviews on emerging MS therapies, with emphasis on anti-CD20 agents, BTK inhibitors, frexalimab, and CAR-T therapy. Eligible studies were critically appraised for mechanisms of action, clinical efficacy, safety, and relevance, with particular focus on recent phase II–III data.Results. This review synthesises current insights into MS immunopathology and recent advances in B-cell-targeted therapies and CAR-T approaches, highlighting an evolving therapeutic landscape focused on improving disease control and long-term outcomes.Conclusions. Continued development of targeted immunotherapies may bring the field closer to sustained remission, effective prevention of progression, and potentially enhanced CNS repair.