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Editor’s note: The disease-modifying therapies (DMTs) interferon-beta and glatiramer acetate represent the therapeutic mainstays in relapsing–remitting multiple sclerosis (MS), but incur high annual costs. Although DMTs have been demonstrated to significantly reduce relapse rates and – to a certain degree – slow disability progression, these treatments do not always prevent patients from eventually converting to a secondary progressive phase of the disease. Current data do not support a beneficial effect of DMTs in MS patients with secondary progressive disease without relapses, in those with severe disability, and in patients with a primary progressive disease course. DMTs cannot therefore be recommended in these MS patients.