Systematic Literature Review of Treatment of Multiple Sclerosis

Multiple Sclerosis (MS) is a chronic immune-mediated neurodegenerative disease with no cure. Currently, there are a multitude of different strategies that aim to prevent the disease’s progression. However, none have proven to be reliable. This systematic literature review aims to compare clinical trials from the past 5 years to evaluate the impact of MS treatments on relapse rates, lesion severity, disability progression, and brain atrophy. A comprehensive search was conducted in Pub-med for published randomized controlled trials conducted within the past 5 years. Keywords such as“Multiple Sclerosis," “brain atrophy,” and, “motor function.,” were used to conduct the search. A total of 9 records were reviewed for this paper. However, five were not used due to repetitive methods, and small sample sizes. The following records were chosen in order to maximize diversity between trials to provide a more comprehensive review. Each trial analyzed was peer-reviewed and reported quantitative data regarding relapse rates and brain atrophy. In total 5 trials were analyzed. Of the five trials, there was one phase I trial, two phase II trials, and two phase III trials. Three trials tested monoclonal antibodies in relapsing remitting multiple sclerosis (RRMS) and primary progressive multiple sclerosis PPMS. Of the 3, 2 were anti-CD20 antibodies (Ofatumumab and Ublituximab) and 1 was anti-CD40 (Frexalimab). One tested neural stem cells in recovering cognitive function, and the last tested teriflunomide in the earliest stage of MS radiologically isolated syndrome (RIS). All trials were conducted with the end purpose of reducing the annual relapse rate (ARR) and number of gadolinium-enhancing lesions GELs in patients. Ublituximab, Frexalimab, Ofatumumab and TERIS all met their primary endpoints with p<0.001. Recent advances in MS therapies have improved disease control. However the majority of new treatments, including the five treatments analyzed in this review, require more long-term data. Monoclonal antibodies such as Ublituximab, Frexalimab, and Ofatumumab have proven to be promising treatments for RRMS. Those with PPMS and SPMS require more intense treatments, and treatment methods such as using stem cells should be further investigated. Early treatment of MS has been found to delay disease progression in the TERIS trial.