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When asked “Is there a cure for MS?“, AI tools (Gemini, ChatGPT or Claude) and the world’s leading research centers and patient associations consistently give the same answer: no. (June 2026)

Yet some patients with a confirmed MS diagnosis live in a clinical condition that closely resembles a “cure”. Following AHSCT — an immune reconstitution therapy — they have remained in NEDA-3 (No Evidence of Disease Activity) for years, in some cases for over two decades: no relapses, no new MRI activity, no disability progression, and no disease-modifying therapy (Havrdova et al., 2009). Patients who are treatment-free and NEDA-3 for at least 15 years may be defined as “cured” under a working definition — a context-specific operational framework (Banwell et al., 2013).

AHSCT has the potential to eliminate the immunological mechanism driving CNS lesion formation and to renew the immune system, reducing its pathological activity against the central nervous system.

Important: AHSCT does not reverse established disability or long-standing neurological deficits. For a detailed discussion, see the AHSCT as a cure section.

If curing MS is a realistic goal, what clinical, radiological, and biological criteria must a patient meet — and for how long — to be defined as “cured”?

The question was first formally addressed in a 2013 editorial by Banwell, Giovannoni, Hawkes, and Lublin in Multiple Sclerosis and Related Disorders (Banwell B. et al., 2013).

NEDA-3, NEDA-4, and NEDA-5 define composite clinical, radiological, and biological endpoints but do not account for the mechanism of action of the therapy used to achieve them. NEDA can be maintained on continuous non-immune-reconstituting DMTs — however, in these patients the immune system has been modulated, not reset, and retains its pathological potential against the CNS. Discontinuation typically leads to relapse and, with certain agents, to disease rebound.

The term sustained disease remission has been applied to patients remaining NEDA-3 for multiple years following AHSCT (Boffa, Massacesi et al., 2021) or other immune reconstitution therapies (Lünemann et al., 2020). No international consensus currently defines the minimum duration of NEDA-3 required to qualify as sustained disease remission, nor whether the term should be restricted to immune reconstitution therapies or extended to all DMTs.

As Giovannoni et al. (2020) noted, defining a cure raises a fundamental question: how long must remission be sustained — 15, 20, 25 years or more — before the term can be applied? The 15-year threshold, proposed by Banwell et al. (2013), aligns with the accepted timepoint for defining benign MS.

In the AHSCT literature, only a small number of patients have reached or exceeded 15 years of NEDA-3 — the threshold at which a working definition of “cure” may be applied. Notably, the Swedish national cohort (Silfverberg et al., 2023) reported 13 patients exceeding 10 years of sustained disease remission following AHSCT performed since 2004. For most patients in published studies, follow-up ranges from a few months to just over 10 years.

On this website, sustained remission and long-term remission refer to patients who have maintained NEDA-3 for several years, regardless of whether this was achieved through continuous DMT treatment or immune reconstitution therapy.

MS is a chronic inflammatory and degenerative disease arising from the interaction of genetic, viral, and environmental factors. Its development is multistep and multifactorial.

Current evidence strongly supports EBV infection as necessary, but not sufficient, for MS to develop (Bjornevik et al., 2022; Mechelli et al., 2025). Genetic predisposition is equally required (Cree et al., 2014). To these two conditions, environmental co-factors must be added — including childhood obesity, vitamin D deficiency, smoking, environmental pollution, and gut microbiome alterations — though their individual roles remain incompletely defined (Zamecnik et al., 2024).

The convergence of these factors leads to immune dysregulation. In people who develop MS, the immune system — beyond its normal defensive role — acquires pathological reactivity against the CNS. This process unfolds in stages: initial production of autoantibodies against nervous system components (detectable in a minority of patients), followed by the emergence of auto-aggressive lymphocytes capable of attacking myelin. These cells clonally expand, penetrate the CNS, and trigger inflammation, manifesting as new MRI lesions and, in some cases, clinical relapses. For a detailed account of MS neuropathology, see Lassmann, 2018.

Over the past 30 years, the therapeutic goal in MS has shifted fundamentally — from simply reducing relapse frequency to achieving complete, durable disease control (Lünemann et al., 2020).

Approximately 20 DMTs are currently available, differing in mechanism of action, efficacy, safety profile, and route of administration. By efficacy, they are classified as low-efficacy (LE-DMTs) or high-efficacy (HE-DMTs). A further distinction concerns the treatment schedule: most DMTs require continuous administration, whereas a subset — immune reconstitution therapies (IRTs) — are administered in short, intermittent courses. IRTs include cladribine, alemtuzumab, and AHSCT.

IRTs act by transiently depleting the immune system, enabling it to regenerate and reconstitute itself. The rebuilt immune system appears substantially less aggressive toward the CNS — an effect that can persist for years, which is why IRTs are used in limited courses (cladribine, alemtuzumab) or as a single procedure (AHSCT).

AHSCT is not a DMT but a multistep procedure. When comparing efficacy among IRTs, AHSCT demonstrates greater potency than alemtuzumab (Häußler et al., 2021; Braun et al., 2024), while alemtuzumab is considered more efficacious than cladribine. Efficacy and risk profile vary depending on the conditioning protocol used.

✅ See the comparative table for a direct comparison of AHSCT with other DMTs.