Fig. 1

Disease-Modifying Therapy of MS. 1 - Azathioprine is formally approved but rarely applied (2nd choice); 2 - Mitoxantrone formally approved here as well as in highly active RRMS but rarely applied due to the unfavorable side effect profile and the cumulative maximum dose (2nd choice); 3 - Natalizumab: both i.v. and s.c.; especially in case of HPyV-2 (JCV) antibody positivity (HPyV-2 [JCV] Ab ≥0.9 HPyV-2 [JCV] Ab titer) risk stratification is essential due to PML risk! High risk for PML after i) prior immunosuppression, ii) ≥ 18 months of continuous therapy, and with iii) positive HPyV-2 (JCV) Ab status; 4 - Interferons: interferon-b-1a i.m., interferon-b-1a s.c., interferon-b-1b s.c., pegylated interferon-b-1a s.c./i.m.; 5 - Glatiramer acetate includes other glatiramoids. 6 - Decisions on type of therapy (as well as therapy concept) depend on the level of disease activity and severity; thus first- and second-line therapies are included here.

Available drugs are listed alphabetically, not by strength or preference.

Scheme from: MSTCG, DGNeurology Kommentar (2021) https://doi.org/10.1007/s42451-021-00353-3