IN a newly published systematic review of clinical trials, researchers evaluated the safety and efficacy of interventions aimed at promoting remyelination in multiple sclerosis (MS), a neurodegenerative disease characterized by inflammation, demyelination, and axonal damage in the central nervous system. The findings present cautious optimism for healthcare professionals seeking therapeutic strategies that go beyond symptom control to directly address the underlying neurological damage.
The review analyzed 25 clinical trials comprising 3,341 participants, drawn from an initial pool of over 1,600 studies across PubMed, Embase, Web of Science, and Cochrane Library databases. Seventeen different interventions were evaluated, many of which demonstrated signs of remyelination potential using advanced neuroimaging and electrophysiological techniques. These included Magnetization Transfer Ratio (MTR), Myelin Water Fraction (MWF), Diffusion Tensor Imaging (DTI), Optical Coherence Tomography (OCT), and Visual Evoked Potentials (VEPs).
Several promising agents emerged, including clemastine fumarate, opicinumab, L-T3, rHIgM22, phenonytoin, domperidone, GSK239512, human fetal neural precursor cells (hfNPCs), and low-intensity repetitive transcranial magnetic stimulation (LI-rTMS). These treatments were generally well tolerated, with only one intervention flagged for safety concerns. Moreover, some existing disease-modifying therapies like Ocrelizumab, Fingolimod, and Natalizumab also showed favorable remyelination effects.
Despite these encouraging results, most of the studies were limited by small sample sizes, moderate risk of bias, and short follow-up periods. Critically, many lacked standardized clinical endpoints that correlate remyelination with meaningful functional improvement, underscoring the need for more robust trial designs. The authors emphasize the importance of integrated therapeutic approaches that combine remyelination, neuroprotection, and immunomodulation to advance the clinical management of MS.
For clinicians and researchers, this review serves as both a status report and a call to action in the pursuit of restorative therapies for MS.
Reference:
Makhzoum H et al. Interventions promoting remyelination in multiple sclerosis: a systematic review of clinical trials. Neurol Res. 2025;1-18.
