Advances in disease-modifying therapies for multiple sclerosis: global updates and a regional comparison between the Republic of Moldova and Romania

Abstract

Introduction. The therapeutic landscape of multiple sclerosis has undergone a remarkable transformation over the past two decades. The paradigm has shifted from reliance on moderate-efficacy, first-generation injectable therapies toward earlier adoption of high-efficacy disease-modifying treatments, particularly in relapsing forms of MS. This evolution reflects an increasing focus on early intensive treatment strategies aimed at preserving long-term neurological function and brain health. Materials and methods. This narrative review synthesizes recent global evidence on progress in disease-modifying treatments across all multiple sclerosis phenotypes, drawing from randomized controlled trials, real-world studies, and expert consensus guidelines. In addition, it includes a comparative health policy analysis assessing DMT availability, access, and implementation in Romania and the Republic of Moldova, based on national formularies, reimbursement frameworks, and care delivery models. Results. Globally, the MS treatment algorithm has been reoriented toward early intensive treatment, supported by emerging evidence favoring high-efficacy therapies in the early disease course. While many countries have aligned their protocols accordingly, regional discrepancies persist. Romania, as an EU member, has expanded patient access to 16 reimbursed therapies and biomarker-driven monitoring, and has developed a network of specialized Multiple Sclerosis centers. Conversely, the Republic of Moldova faces structural and economic barriers that restrict access to high-efficacy treatments, advanced diagnostics, and multidisciplinary care – factors contributing to delayed treatment and suboptimal outcomes. Conclusions. Understanding both global innovations and regional realities is necessary to place current Multiple Sclerosis care in context. Further advancements in science, health policy, and infrastructure will ultimately determine how effectively different nations can convert therapeutic progress into actual improvements in patient outcomes.