Multiple sclerosis (MS) is a central nervous system inflammatory demyelinating disorder affecting millions of young patients globally. Over the past two decades, more than ten disease-modifying drugs (DMTs) have become available, offering varying levels of efficacy, routes of administration, and adverse effect profiles. The appropriate use of these DMTs in MS patients, who exhibit heterogeneous clinical features and severity, requires careful consideration and shared decision-making, taking into account patient preferences and expectations. The introduction highlights the pathophysiology of MS, emphasizing the role of T cells, B cells, and myeloid cells in disease progression. It also discusses the etiology, risk factors, and prognostic factors associated with MS, including genetic and environmental factors. The section on DMTs outlines the classification of these drugs based on their effectiveness and pharmacological mechanisms. Low-efficacy DMTs like interferon beta (IFNβ) and glatiramer acetate are discussed, followed by moderate-efficacy drugs such as dimethyl fumarate (DMF). Moderate-to-high-efficacy DMTs, including sphingosine-1-phosphate receptor modulators (S1PR modulators) and B-cell-depleting therapies, are detailed. High-efficacy DMTs, such as natalizumab and alemtuzumab, are also covered, along with their respective benefits and risks. The article emphasizes the importance of personalized treatment approaches, considering the diverse clinical features and responses of MS patients. It advocates for shared decision-making to ensure that patients understand the potential efficacy, benefits, and risks of DMTs.Multiple sclerosis (MS) is a central nervous system inflammatory demyelinating disorder affecting millions of young patients globally. Over the past two decades, more than ten disease-modifying drugs (DMTs) have become available, offering varying levels of efficacy, routes of administration, and adverse effect profiles. The appropriate use of these DMTs in MS patients, who exhibit heterogeneous clinical features and severity, requires careful consideration and shared decision-making, taking into account patient preferences and expectations. The introduction highlights the pathophysiology of MS, emphasizing the role of T cells, B cells, and myeloid cells in disease progression. It also discusses the etiology, risk factors, and prognostic factors associated with MS, including genetic and environmental factors. The section on DMTs outlines the classification of these drugs based on their effectiveness and pharmacological mechanisms. Low-efficacy DMTs like interferon beta (IFNβ) and glatiramer acetate are discussed, followed by moderate-efficacy drugs such as dimethyl fumarate (DMF). Moderate-to-high-efficacy DMTs, including sphingosine-1-phosphate receptor modulators (S1PR modulators) and B-cell-depleting therapies, are detailed. High-efficacy DMTs, such as natalizumab and alemtuzumab, are also covered, along with their respective benefits and risks. The article emphasizes the importance of personalized treatment approaches, considering the diverse clinical features and responses of MS patients. It advocates for shared decision-making to ensure that patients understand the potential efficacy, benefits, and risks of DMTs.