This year marks the 25th anniversary of the publication of the Betaseron phase III study (Interferon-beta MS Study Group. Neurology 1993;43:655-661), which ushered in the era of disease-modifying therapies in the treatment of multiple sclerosis. In the usual course of things, first-generation agents – especially drugs administered by injection – would be superseded by novel therapies, either a more convenient oral agent (fingolimod, teriflunomide, dimethyl fumarate, cladribine) or a more potent infusion drug (natalizumab, alemtuzumab, ocrelizumab). Market shares have shifted but all treatments remain available, resulting in the present state of a surprisingly lengthy list of options. This raises the questions: are so many medications needed, and what is the role of injectable agents in MS management?