Targeted Interventions in HAM/TSP: Emerging Therapies and Future Directions – A Narrative Review

Background and Aim Human T‐Lymphotropic virus type 1 (HTLV‐1) infection can lead to HTLV‐1‐associated myelopathy/tropical spastic paraparesis (HAM/TSP), a debilitating chronic neurological disease characterized by progressive lower limb spasticity and autonomic dysfunction. Because the exact disease pathogenesis remains unclear and current management options have limited efficacy, there is a critical need for more effective therapies to reduce morbidity and mortality. This narrative review aims to review the available and diverse range of emerging treatment approaches for HAM/TSP. Methods A comprehensive narrative review of the existing literature was conducted to assess current treatment methods, historical treatment efforts, and modern therapeutic interventions. The scope includes pharmacological, immunological, targeted, and non‐pharmacological strategies aimed at disease management. Results Current disease‐modifying therapies primarily rely on immunomodulatory agents, such as corticosteroids and interferon‐alpha, to mitigate neuroinflammation and preserve motor function, whereas traditional antiretroviral therapies demonstrate limited clinical efficacy. Emerging targeted therapies, notably the monoclonal antibody mogamulizumab, show significant promise in reducing HTLV‐1‐infected cells and sustaining a decrease in spinal cord inflammation. Furthermore, comprehensive care must integrate treatments targeting specific cellular signaling pathways alongside vital non‐pharmacological interventions, such as physical rehabilitation and psychological support. Conclusion The effective management of HAM/TSP necessitates a holistic, multidisciplinary approach encompassing targeted pharmacotherapy, symptomatic management, and psychosocial support. While novel interventions and disease‐modifying therapies offer promising new directions, further high‐quality, randomized clinical trials are essential to establish standard regimens, optimize dosages, and ensure long‐term efficacy and safety.