# Treatment options for progressive multiple sclerosis
The treatment of progressive multiple sclerosis has been in motion in recent years. For a long time there were few options, but there are now some medicines available that can slow down progression. The choice depends on your specific form of progressive MS, how active the disease is on MRI scans, and how your body responds.
Immune system-suppressing medicines (monoclonal antibodies)
Ocrelizumab
ProveniIncluded in official guidelines, or approved by EMA or FDA
Ocrelizumab is a medicine that attacks certain immune cells (B-cells). It is used in both primary progressive MS and secondary progressive MS with active inflammation.
The medicine works by removing B-cells from the blood and nerve tissue. B-cells play a role in damaging the nerves. With fewer B-cells, inflammatory activity usually decreases.
Common side effects are infections (especially respiratory tract infections), fatigue, headaches and reactions to the infusion itself — chills, flushing or shortness of breath. Because the immune system is weakened, the risk of infection increases. Certain infections (such as serious bacterial infections and in rare cases PML, a viral brain disease) have been reported, although this is rare.
Natalizumab
ProveniIncluded in official guidelines, or approved by EMA or FDA
Natalizumab blocks a protein on immune cells so they can less easily cross the blood-brain barrier. This reduces inflammation in the nervous system.
It is mainly used in secondary progressive MS with demonstrable inflammatory activity on MRI or recent relapses.
Side effects are similar to other immunosuppressants. The main risk is PML (progressive multifocal leukoencephalopathy), a rare viral brain infection. This risk depends on your previous exposure to the JC virus. Regular monitoring via blood tests is standard. Infusion reactions also occur.
Siponimod
ProveniIncluded in official guidelines, or approved by EMA or FDA
Siponimod is an oral medicine that blocks S1P receptors, which prevents immune cells in lymph nodes. This way fewer immune cells reach the nerve tissues.
This medicine has been specially well studied for secondary progressive MS. It is taken daily as a tablet.
Side effects include heart rhythm disorders (especially on the first day), infections, elevation of liver enzymes, and headache. Before you start your heart will be checked.
Bruton's tyrosine kinase inhibitors (Btk inhibitors)
Tolebrutinib
ProveniIncluded in official guidelines, or approved by EMA or FDA
Tolebrutinib inhibits an enzyme (Bruton's tyrosine kinase) that is important for cell-mediated immune response. It works on both B and T cells and microglial cells (inflammatory cells in the brain itself).
This medicine was recently approved for primary progressive MS and secondary progressive MS. It is taken orally.
Side effects are mainly infections (bacterial and viral), elevation of liver enzymes (hence regular liver monitoring), abdominal pain, and diarrhoea. Heart rhythm disorders and neurological side effects have also been reported.
Orelabrutinib
ResearchediPositive results in clinical studies, not yet standard treatment
Orelabrutinib is a similar Btk inhibitor currently being investigated in clinical trials for both primary and secondary progressive MS (studies running in 2026).
The mechanism of action is similar to tolebrutinib. Side effects appear to be similar, but definitive safety data from phase 3 trials are not yet complete.
Regeneration and recovery stimulation
Mesenchymal stem cell transplantation
ResearchediPositive results in clinical studies, not yet standard treatment
Mesenchymal stem cells are cells from your own bone marrow or fatty tissue that can be cultured and brought back into your body. The idea is that they can reduce inflammation and possibly repair nerve tissue.
Various studies are investigating this for progressive MS. The results so far are mixed: some patients show stabilization or improvement of symptoms, but it is not yet clear how this works and for whom it works best.
Side effects depend on how the cells are administered (usually via infusion). Infections, transfusion reactions and immune responses can occur.
Neural stem cell supernatant (S103)
ExperimentaliOngoing in study setting, outcome still unknown
S103 is an experiment in which a fluid from cultured neural stem cells is injected into the cerebrospinal fluid (brain fluid). The idea is that this fluid works anti-inflammatory and encourages nerve growth.
This is still in clinical trials (2026) and is not routinely available.
Supportive treatments
Physiotherapy and rehabilitation
ProveniIncluded in official guidelines, or approved by EMA or FDA
Although physiotherapy does not stop the underlying progression, it helps against fatigue, muscle atrophy and mobility decline. Exercise programmes are often tailored to your remaining ability.
This is considered standard support alongside medication.
Cognitive rehabilitation
ResearchediPositive results in clinical studies, not yet standard treatment
Progressive MS is sometimes accompanied by memory and concentration problems. Targeted exercise programmes (computer programmes, speech therapy) can help, although the evidence is still growing.
Treatment of additional symptoms
ProveniIncluded in official guidelines, or approved by EMA or FDA
Symptoms such as spasticity (muscle cramps), pain, bladder dysfunction and depression are treated separately with physiotherapy, medication and psychological support — not primarily aimed at MS itself, but at quality of life.
Tests that monitor your progression
Regular MRI scans of your brain and spinal cord help your doctor see if the medication is working. Sometimes your cerebrospinal fluid is also examined (spinal tap) and blood is tested for markers that indicate inflammation activity. This helps in deciding to adjust medications.
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_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._