Multiple sclerosis
(
MS
) is a severe, debilitating disease that affects more than a million individuals worldwide. Unfortunately, most aspects of this disease are poorly understood, thereby making drug discovery efforts particularly challenging. Historically, therapeutics for MS have relied on broad immunosuppression, and therefore these agents cause significant limiting side effects. Many of these older drugs were developed first as cancer therapeutics, and their ability to prevent the proliferation of immune cells was exploited in treating MS patients. Other current frontline therapies include immunosuppressants and immunomodulators that originally found use in inflammatory or other automimmune disorders. Current efforts are focusing on a more subtle approach at immunomodulation that target specific aspects of the immune response or putative MS autoantigens. This chapter provides an overview of currently approved therapies, including small‐molecule and protein‐based therapeutics as well as a more detailed review of promising new approaches, particularly those with a medicinal chemistry component.