In this issue of JAMA Neurology, an open-label study by Negrotto et al1 investigates the effect of oral antidiabetic medications on paraclinical outcome measures in 50 obese patients with multiple sclerosis (MS) and metabolic syndrome. In this study, 20 patients receiving metformin hydrochloride and 10 receiving pioglitazone hydrochloride had significantly fewer new or enlarging T2 lesions or gadolinium-enhancing lesions confirmed by brain magnetic resonance imaging after about 2 years of treatment compared with a control group of 20 patients with MS and metabolic syndrome who did not receive metformin or pioglitazone.