Assembled by software from public sources.
Protecting and repairing
Can nerve fibres be protected and lost myelin rebuilt?
No treatment yet0 confirmed · 23 running · 10 failed
In short
The brain can rebuild lost myelin, but in MS the repair often stalls, and nerve fibres that lose their myelin can die.
Repairing myelin and protecting nerve fibres are the main hopes for restoring lost function and preventing lasting disability. Rehabilitation and other treatments can also improve function without repairing the underlying damage.
Early trials have shown that repair can be measured in people. None has yet shown a lasting gain in everyday function.
Where we are
- No treatment is confirmed to repair myelin or protect nerve fibres in people. Several did in animals.
- The clearest phase 2 signal is clemastine on nerve conduction (2017). The largest attempt, opicinumab, failed in phase 2b, and PIPE-307 missed its main goal in 2025 by the company's report.
- Measuring repair is the bottleneck: MRI myelin measures and visual evoked potentials are still being validated as trial outcomes.
- Metformin and other candidates from laboratory screens are in phase 2.
Written by the editors from the records below. Last reviewed 6 November 2026. Not yet reviewed by an MS specialist.
The evidence
What works
- Thioctic acid · Secondary progressive MS
Thioctic acid · 1 trial running
- Clemastine · Relapsing MS
Clemastine · 1 trial running
- Phenytoin · MS (type not specified)
Phenytoin
Being tested
- Immune reconstitution (cladribine, alemtuzumab, aHSCT) · Relapsing and progressive MS
Cladribine · 2 trials running
- B-cell depletion (anti-CD20) · Relapsing MS
Ocrelizumab · 2 trials running
- Tenofovir alafenamide · MS (type not specified)
Tenofovir alafenamide · 1 trial running
- B-cell depletion (anti-CD20) · Relapsing and progressive MS
Ocrelizumab · 1 trial running
Did not work
- Epoetin alfa · Optic neuritis
Epoetin alfa
- Fluoxetine · Secondary progressive MS
Fluoxetine
- Amiloride · Secondary progressive MS
Amiloride
- Opicinumab · Optic neuritis
Opicinumab
- Fumarates / NRF2 · Primary progressive MS
Dimethyl fumarate
What comes next
Results due and trials to watch
- NACPMS
Acetylcysteine · Progressive MS · Feb 2027
- CLASP-MS
Cladribine · Relapsing and progressive MS · Jun 2027
Open questions
Further reading
Reviews and guidelines
No reviews are linked to this area yet.
Lab research
No lab studies are linked to this area yet.
References
The sources behind this area's background are listed with its Research background in MS in depth. Every trial, hypothesis, review and lab study above links to its own record.