Over the past 30 years, the number of drugs approved for multiple sclerosis has gone from zero to more than 15, with several dosing variations and generic versions. Despite this great progress, current multiple sclerosis treatments seem to predominantly benefit the inflammatory lesion activity that underlies relapsing multiple sclerosis, leaving the progressive aspects (ie, gradual disability worsening without clinical relapses) mostly unabated. Siponimod and ocrelizumab are two agents with regulatory approval for progressive forms of multiple sclerosis (primary progressive and secondary progressive multiple sclerosis); these drugs provide the most benefit to patients with clinical relapses or disease activity on MRI.^,  As a result, when US and European regulators recommended approval of siponimod for secondary progressive multiple sclerosis, they restricted its use to patients with active disease. Treatments for patients with progressive multiple sclerosis who do not have active disease are scarce.

中文翻译：

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多发性硬化症治疗中的盛宴或饥荒。

在过去的30年中，批准用于多发性硬化症的药物数量已从零增加到超过15种，并有几种剂量变化和通用版本。尽管取得了巨大进步，当前的多发性硬化症治疗似乎主要有益于复发性多发性硬化症基础的炎性病变活动，而使进展性方面（即，渐进性残疾加重而没有临床复发）大部分没有减弱。Siponimod和ocrelizumab是两种药物，已获得监管机构批准用于进行性多发性硬化（原发性进行性和继发性进行性多发性硬化）。这些药物为具有MRI的临床复发或疾病活动的患者提供最大的益处。^， 结果，当美国和欧洲监管机构建议批准使用siponimod用于继发性进行性多发性硬化症时，他们将其用于活动性疾病的患者。对于没有活动性疾病的进行性多发性硬化症患者的治疗是稀缺的。