Current approaches to pathogenic treatment of multiple sclerosis (MS), decision-making algorithms for prescription of the first-line disease modifying drugs (beta-interferons and glatiramer acetate), changing in the treatment in case of drug resistance and non-optimal response to treatment with the following switching to the second-line drugs (fingolimod, natalizumab, mitoxantron) as well as main principles and treatment strategy are analyzed. All drugs are discussed in the aspect of adverse effect management. Special attention is drawn to long-term treatment adherence.