Relapsing MS treatment remains difficult, and new therapeutic targets have been investigated. S1P, a bioactive lysophospholipid signaling molecule present in several organs, including the central nervous system, is one such target. S1P plays a role in a variety of physiologic and pathophysiologic processes. S1P levels have been linked to disease progression in the brain parenchyma and cerebrospinal fluid of MS patients. There are 5 recognized S1PR subtypes, and depending on the receptor being targeted, their expression patterns and outcomes change. S1PRMs are a more recent class of RMS treatments, and the FDA has currently approved 4 of these treatments: fingolimod, siponimod, ozanimod, and ponesimod.