Effectiveness of combination therapy versus monotherapy in multiple sclerosis: A systematic review and meta-analysis

Multiple sclerosis (MS) is a chronic autoimmune disorder of the central nervous system (CNS) and the leading cause of non-traumatic neurological disability in young adults. Although current disease-modifying therapies (DMTs), such as interferon beta (IFN?) and glatiramer acetate, can reduce inflammation and delay disease progression, many patients continue to experience relapses. Given the complexity and variability of MS, combination therapy targeting multiple disease mechanisms is being explored as a more effective treatment approach. A comprehensive search of Medline and EMBASE databases was conducted using keywords related to MS, immunomodulatory agents, and combination therapy. Additional clinical trials were identified through the National MS Society database. A limited number of studies have investigated the use of IFN? with or without immunosuppressive agents. Preliminary findings suggest potential benefits of combination therapy, though evidence is constrained by small sample sizes, lack of randomization, and limited follow-up periods. Combination therapies may offer enhanced therapeutic effects in MS management. However, more rigorous and large-scale clinical trials are required to confirm their safety and efficacy.