OBJECTIVES: The aim of this study was to synthesize he evidence of clinical outcomes for alemtuzumab, cladribine, daclizumab, dimethyl fumarate, fingolimod, glatiramer acetate, interferons, natalizumab, ocrelizumab, peginterferon and teriflunomide in adults with relapsing-remitting multiple sclerosis. METHODS: A systematic review was performed by Medline, Scopus and manual search (May 2017). Bayesian network meta-analyzes were conducted, of randomized clinical trials that evaluated any of the disease modifying therapies head-to-head or against placebo. Surface Under the Cumulative Ranking analysis (SUCRA), Cochrane tool for risk of bias (v2.0) and GRADE were used to ranking therapies, assess methodological bias, and quality of general evidence, respectively. RESULTS: Twenty-nine studies were included in the meta-analyzes. The most effective therapies considering the outcome annualized relapse rate were alemtuzumab, natalizumab, and ocrelizumab [HR versus placebo, of 0.30, 0.31 and 0.36, respectively (p < 0.05 for all comparisons)], without significant differences between these three therapies. Discontinuation due to adverse events (96-weeks) revealed similarity across all therapies, except for alemtuzumab, which showed less discontinuation when compared to interferon 1a [RR 0.37 (p < 0.05)]. CONCLUSIONS: Alemtuzumab, natalizumab, and ocrelizumab are the best choices considering clinical efficacy without compromising patient’s safety (high quality evidence).