Patient description: The patient is a 20 year old Caucasian female presents to the clinic with one-sided vision lost and facial weakness, dysarthria and numbness lasting for 1 day. She visited her PCP and underwent brain MRI which revealed a single plaque in the brainstem. After few months, she experienced lower extremities weakness led to balance problem. The second MRI revealed another lesion in the left cerebral hemisphere. The diagnosis of Relapsing Remitting Multiple Sclerosis (RRMS) is confirmed after the second MRI. Her past surgical history is significant for a C-section 2 years ago and she has a one child. She is divorced and is not currently in any sexual relationship. She smokes 10 cigarettes per day and drinks alcohol occasionally. She is working as an editor in a publisher company and she is happy that she can keep working from home most of the time. She is under the treatment of RRMS from 7 months ago.

Clinical trial eligibility criteria: eligible ages (years): 18.0-65.0,  Relapsing Remitting Multiple Sclerosis Secondary Progressive Multiple Sclerosis Primary Progressive Multiple Sclerosis MS diagnosis and definition of disease course according to the 2017 McDonald Expanded disability status scale (EDSS) ≤6.5 Fulfilling for active MS Treatment naïve relapsing remitting multiple sclerosis (RRMS) patients (never treated, or no DMT the previous 2 years): 1. ▪≥2 relapse previous 12 months OR 2. 1 relapse previous 12 months with severe residual symptoms and EDSS ≥ 3.0 OR 3. 1 relapse previous 12 months AND ≥9 T2 lesions on brain and/or spinal cord MRI AND contrast-enhancing lesion or ≥1 new or enlarging T2 lesion on brain and/or spinal cord MRI previous 12 month Previously treated RRMS patients: 1. ≥1 relapse previous 12 months OR 2. ≥1 contrast-enhancing lesion or ≥2 new/enlarging T2 lesions on brain and/or spinal cord MRI previous 12 months Progressive MS patients: 1. ≥1 relapse previous 12 months OR 2. ≥1 contrast-enhancing lesion previous 12 months or ≥1 new/enlarging T2 lesions on brain and/or spinal cord MRI previous 12 months or ≥2 new or enlarging T2 lesion on brain and/or spinal cord MRI previous 24 months OR 3. Increased levels of neurofilament light chain (NFL) in serum or cerebrospinal fluid (CSF) in sample collected previous 12 months. Progressive MS patients not fulfilling the clinical/MRI for active disease, may qualify for in the study if: (A) CSF NFL level >600 ng/L (measured with NF-Light® ELISA assay from Uman Diagnostics) or serum NFL level >11.5 pg/ml (measured with Simoa™ NF-light® Advantage Kit) Signed written informed consent  Pregnancy or breast feeding Lack of effective contraception for women of child-bearing potential (effective contraception oral contraception, intrauterine devices and other forms of contraception with failure rate <1%) Receipt of a live or live-attenuated vaccine within 6 weeks prior to randomization Known active malignant disease Severe heart failure (New York Heart Association Class IV) or severe, uncontrolled cardiac disease Positive test for HIV, hepatitis B or C, or tuberculosis Negative test for varicella zoster Lymphopenia grade 2 (0.5 to 0.8 × 10^9/L) or higher grades of lymphopenia (in case of switching from fingolimod lymphopenia grade 2 can be accepted if lymphocytes are rising markedly compared to on treatment levels) Neutropenia grade 2 (1.0 to 1.5 × 10^9/L) or higher grades Thrombocytopenia grade 2 (50 to 75 × 10^9/L) or higher grades