Table 1.

Mechanism of action of FDA-approved DMT.

DMT	Commercial Name	Approved Indication	Proposed Mechanism (If Available)	Route of Administration
Dimethyl fumarate	Tecfidera	CIS, relapsing MS	Changes cytokine balance by inhibiting NrF2	Oral
Fingolimod	Gilenya	CIS, relapsing MS	Sphingosine-1-phosphate receptor modulator	Oral
Siponimod	Mayzent	CIS, relapsing MS (including active SPMS)	Sphingosine-1-phosphate receptor modulator (1 and 5)	Oral
Teriflunomide	Aubagio	CIS, RRMS	Mitochondrial dihydro-orotate dehydrogenase (DHODH) inhibitor	Oral
Cladribine	Mavenclad	Relapsing MS (including active SPMS)	Synthetic deoxyadenosine analogue, long lasting lymphocyte depletion	Oral
Glatiramer acetate (GA)	Copaxone	CIS, RRMS	Promotes anti-inflammatory response	Injectable
Interferons	Avonex, Rebif, Plegridy, Betaseron, Betaferon, Extavia	CIS, RRMS	Changes cytokine balance, favors anti-inflammatory cytokines	Injectable
Alemtuzumab	Lemtrada	Aggressive RRMS	Monoclonal antibody, anti-CD52, long lasting lymphocyte depletion	Infusion
Mitoxantrone	Novantrone	Aggressive RRMS, SPMS, and PRMS	Immunosuppressant (type II topoisomerase inhibitor)	Infusion (every 3 months)
Natalizumab	Tysabri	RRMS	Monoclonal antibody; limits T cell transmigration through the blood brain barrier	Infusion (every month)
Ocrelizumab	Ocrevus	RRMS and PPMS	Monoclonal antibody, anti-CD20, depletes B cells	Infusion

PPMS: primary progressive MS, SPMS: secondary progressive MS, PRMS: progressive relapsing MS, RRMS: relapsing remitting MS, CIS: clinically isolated syndrome, DMT: disease modifying treatment