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[Comment] Primary progressive multiple sclerosis—why we are failing

In The Lancet, Fred Lublin and colleagues1 report negative results of a randomised, double-blind trial (INFORMS) assessing the efficacy of fingolimod, an oral sphingosine 1-phosphate receptor (S1PR) modulator, on disability progression in patients with primary progressive multiple sclerosis. This result is particularly disappointing because no US Food and Drug Administration (FDA)-approved disease-modifying therapies exist for primary progressive multiple sclerosis at present. In contrast to drastic advances during the past 20 years in treatment of relapsing multiple sclerosis, the number of unsuccessful studies in primary progressive multiple sclerosis is substantial.