Personalized Treatment for Multiple Sclerosis: The Role of Precision Medicine

Document Type : Review Article

Author

Amity University Jaipur, Rajasthan, Jaipur, Rajasthan, India

Abstract

Multiple Sclerosis (MS) is a chronic, autoimmune, demyelinating disease of the central nervous system. It is a complex and heterogeneous disease, and its pathogenesis is still not completely understood. Precision medicine, which involves the use of advanced technologies such as genomics, proteomics, metabolomics, and imaging to identify specific biomarkers and disease subtypes, is a promising approach to the management of multiple sclerosis. Precision medicine in MS includes the development of targeted therapies that aim to modulate specific immune pathways involved in MS pathogenesis. This review article aims to provide an overview of the current status and future directions of precision medicine in MS. The article discusses the importance of precision diagnostics in MS, including the identification of biomarkers and imaging techniques for MS, as well as the challenges and opportunities of personalized treatment in MS. Targeted therapies in MS are also discussed, including the challenges of developing and implementing these therapies. The article highlights the potential of combination therapies in MS, and the role of AI and ML in improving biomarker identification. The challenges of implementing precision medicine in clinical practice are also addressed, including the standardization of diagnostic criteria and treatment guidelines, and the ethical and legal considerations of personalized treatment. Overall, precision medicine represents a promising approach to the management of MS, with the potential to improve diagnosis, prognosis, and treatment outcomes. However, the implementation of precision medicine in MS clinical practice requires addressing several challenges, including the standardization of diagnostic criteria and treatment guidelines, and the development of affordable and accessible technologies and therapies. With continued research and advances in technology, precision medicine has the potential to transform the field of MS research and clinical practice.

Keywords

Main Subjects

Introduction

Multiple sclerosis (MS) is a chronic and progressive autoimmune disorder of the central nervous system (CNS) that primarily affects young adults. MS is characterized by a wide spectrum of neurological symptoms, including sensory and motor dysfunction, visual impairment, and cognitive deficits. The etiology and pathogenesis of MS are complex and multifactorial, with a combination of genetic and environmental factors implicated in its development and progression (1). Despite significant advancements in MS research, the underlying mechanisms of the disease remain poorly understood, and there is currently no cure for MS (2).

Precision medicine is an emerging approach to healthcare that aims to optimize medical treatment by tailoring it to the specific characteristics of each patient. Precision medicine is based on the idea that individuals differ in many aspects, including their genetics, lifestyle, and environment, and that these differences can have a significant impact on disease development and response to treatment (3). Therefore, by taking into account these individual differences, precision medicine can help to identify the most effective treatment strategies for each patient.

In recent years, precision medicine has gained increasing attention in MS research and clinical practice. The application of precision medicine in MS involves the use of advanced technologies, such as genomics, proteomics, metabolomics, and imaging, to identify specific biomarkers and disease subtypes, which can be used to guide treatment decisions (4, 5). Precision medicine in MS also includes the development of targeted therapies that aim to modulate specific immune pathways involved in MS pathogenesis.

The potential benefits of precision medicine in MS are significant. By identifying biomarkers and disease subtypes, precision medicine can help to diagnose MS earlier and more accurately, as well as predict disease course and response to treatment. Furthermore, by developing targeted therapies, precision medicine can improve treatment efficacy and reduce the risk of adverse effects (6).

Despite its promise, precision medicine in MS also faces several challenges. For example, the identification of biomarkers and disease subtypes can be complex, requiring the use of expensive and sophisticated technologies (7). In addition, the development of targeted therapies can be time-consuming and costly, and the efficacy of these therapies may vary depending on disease stage and patient characteristics (8).

Precision medicine represents a promising approach to the management of MS. The application of precision medicine in MS research and clinical practice has the potential to improve diagnosis, prognosis, and treatment outcomes (9). However, the implementation of precision medicine in MS also requires addressing several challenges, including the development of affordable and accessible technologies and therapies.

 

Precision Diagnostics in Multiple Sclerosis: Biomarkers and Imaging Techniques

Precision diagnostics is a critical component of precision medicine in MS. The identification of accurate and reliable biomarkers and imaging techniques can help to diagnose MS earlier and more accurately, predict disease course and response to treatment, and monitor disease progression. In recent years, significant progress has been made in the development of biomarkers and imaging techniques for MS (10).

Biomarkers are measurable indicators of biological processes that can be used to diagnose, monitor, and predict disease. In MS, biomarkers can be classified into several categories, including genetic, epigenetic, proteomic, and metabolomic biomarkers (11). Genetic biomarkers involve the identification of genetic variants associated with increased risk of MS or disease progression. Epigenetic biomarkers involve the analysis of DNA methylation patterns that can be used to predict disease course and treatment response (12). Proteomic biomarkers involve the analysis of protein expression patterns that can be used to diagnose and monitor disease. Metabolomic biomarkers involve the analysis of metabolic profiles that can be used to predict disease course and treatment response.

Imaging techniques are also critical for the diagnosis and monitoring of MS. Magnetic resonance imaging (MRI) is the most commonly used imaging technique for MS, and it can provide valuable information about the location, extent, and severity of MS lesions in the brain and spinal cord. Advanced MRI techniques, such as diffusion tensor imaging (DTI), functional MRI (fMRI), and magnetic resonance spectroscopy (MRS), can provide additional information about the microstructural and functional changes in the CNS associated with MS (13, 14). Other imaging techniques, such as optical coherence tomography (OCT) and positron emission tomography (PET), can be used to assess changes in the retina and metabolic activity in the brain, respectively (15).

Despite significant advancements in biomarker and imaging technologies for MS, several challenges remain. For example, the identification of reliable and specific biomarkers for MS can be challenging, as many of the identified biomarkers may be associated with other diseases or conditions (16). In addition, the use of advanced imaging techniques can be expensive, time-consuming, and require specialized expertise.

Precision diagnostics is essential for the successful implementation of precision medicine in MS. The development of accurate and reliable biomarkers and imaging techniques can improve the diagnosis, prognosis, and treatment of MS (17). However, the implementation of precision diagnostics in MS also requires addressing several challenges, including the development of affordable and accessible technologies and the standardization of diagnostic criteria.

 

Targeted Therapies in Multiple Sclerosis: Role of Precision Medicine

Targeted therapies are a critical component of precision medicine in MS. Targeted therapies aim to modulate specific immune pathways involved in MS pathogenesis, with the goal of reducing disease activity and preventing further damage to the CNS. In recent years, significant progress has been made in the development of targeted therapies for MS (18).

The primary targets of targeted therapies in MS are immune cells and cytokines involved in the immune response. For example, monoclonal antibodies targeting CD20, such as rituximab and ocrelizumab, have been shown to reduce B-cell activity and disease activity in MS. Similarly, monoclonal antibodies targeting alpha-4 integrin, such as natalizumab and vedolizumab, have been shown to reduce T-cell activity and disease activity in MS (12, 19). Other targeted therapies, such as sphingosine-1-phosphate receptor modulators, have been shown to reduce lymphocyte migration and prevent further CNS damage.

The development of targeted therapies in MS is guided by the identification of specific biomarkers and disease subtypes (20). For example, the presence of certain genetic variants or biomarkers, such as antibodies to certain proteins, may indicate a better response to certain targeted therapies. Furthermore, disease subtypes, such as relapsing-remitting MS or progressive MS, may respond differently to targeted therapies, and the identification of disease subtypes can help to guide treatment decisions (21).

Despite significant advancements in targeted therapies for MS, several challenges remain. For example, the development of targeted therapies can be time-consuming and costly, and the efficacy of these therapies may vary depending on disease stage and patient characteristics (22). In addition, the use of targeted therapies may be associated with adverse effects, such as increased risk of infections or malignancies.

Targeted therapies represent a promising approach to the management of MS. The development of targeted therapies in MS is guided by the identification of specific biomarkers and disease subtypes, and the use of targeted therapies can improve treatment efficacy and reduce the risk of adverse effects (23, 24). However, the implementation of targeted therapies in MS also requires addressing several challenges, including the development of affordable and accessible therapies and the standardization of treatment guidelines.

 

Personalized Treatment in Multiple Sclerosis: Challenges and Opportunities

Personalized treatment is the ultimate goal of precision medicine in multiple sclerosis (MS). Personalized treatment involves tailoring treatment strategies to the specific characteristics of each patient, including their genetics, lifestyle, and environment (25, 26). Personalized treatment in MS has the potential to improve treatment outcomes, reduce adverse effects, and optimize healthcare resource utilization. However, the implementation of personalized treatment in MS also faces several challenges (27).

One of the main challenges of personalized treatment in MS is the identification of reliable and specific biomarkers and disease subtypes (28). The identification of biomarkers and disease subtypes can be complex, requiring the use of expensive and sophisticated technologies. Furthermore, the identification of reliable biomarkers and disease subtypes may require large-scale studies involving diverse populations, which can be time-consuming and costly (29).

Another challenge of personalized treatment in MS is the development of targeted therapies that can address the specific characteristics of each patient. The development of targeted therapies can be time-consuming and costly, and the efficacy of these therapies may vary depending on disease stage and patient characteristics (30, 31). Furthermore, the use of targeted therapies may be associated with adverse effects, such as increased risk of infections or malignancies.

The implementation of personalized treatment in MS also requires addressing several ethical and legal challenges. For example, the use of genetic information and other personal data for personalized treatment raises concerns about privacy and discrimination. Furthermore, the development and use of targeted therapies may raise concerns about access and affordability for patients from diverse socioeconomic backgrounds (32, 33).

Despite these challenges, personalized treatment in MS also presents several opportunities. Personalized treatment can improve treatment outcomes and reduce adverse effects, which can have significant benefits for patients and healthcare systems (34). Furthermore, the development of targeted therapies can drive innovation in MS research and clinical practice, leading to new insights into MS pathogenesis and new treatment strategies (35).

Personalized treatment represents the ultimate goal of precision medicine in MS. The implementation of personalized treatment in MS requires addressing several challenges, including the identification of reliable biomarkers and disease subtypes, the development of targeted therapies, and the ethical and legal considerations of personalized treatment (36, 37). However, personalized treatment in MS also presents several opportunities for improving treatment outcomes and driving innovation in MS research and clinical practice.

 

Future Directions of Precision Medicine in Multiple Sclerosis

Precision medicine is an emerging approach to healthcare that has the potential to transform the management of MS (38). The application of precision medicine in MS involves the use of advanced technologies, such as genomics, proteomics, metabolomics, and imaging, to identify specific biomarkers and disease subtypes, which can be used to guide treatment decisions (39, 40). Furthermore, precision medicine in MS includes the development of targeted therapies that aim to modulate specific immune pathways involved in MS pathogenesis (41). The future directions of precision medicine in MS involve expanding the scope of precision medicine to include novel technologies and strategies, as well as addressing the challenges of implementing precision medicine in clinical practice (42).

One promising direction of precision medicine in MS is the use of artificial intelligence (AI) and machine learning (ML) to improve the identification of biomarkers and disease subtypes (43, 44). AI and ML can analyze large datasets of clinical, genetic, and imaging data to identify patterns and associations that may be missed by traditional statistical methods. Furthermore, AI and ML can be used to develop predictive models that can help to identify patients at risk of developing MS or predict disease course and treatment response.

Another promising direction of precision medicine in MS is the development of combination therapies that target multiple immune pathways involved in MS pathogenesis (45). Combination therapies may have higher efficacy than single-target therapies and may reduce the risk of treatment resistance or adverse effects. Furthermore, the development of combination therapies may require the identification of novel biomarkers and disease subtypes, which can further advance the field of precision medicine in MS (46).

The implementation of precision medicine in MS also requires addressing several challenges, including the standardization of diagnostic criteria and treatment guidelines, the development of affordable and accessible technologies and therapies, and the ethical and legal considerations of personalized treatment. Future directions of precision medicine in MS should aim to address these challenges and improve the integration of precision medicine in clinical practice.

In conclusion, precision medicine represents a promising approach to the management of MS. The future directions of precision medicine in MS involve expanding the scope of precision medicine to include novel technologies and strategies, as well as addressing the challenges of implementing precision medicine in clinical practice. The integration of precision medicine in MS clinical practice has the potential to improve diagnosis, prognosis, and treatment outcomes, and transform the field of MS research and clinical practice.

 

Deceleration

 

Funding

We do not have any financial support for this study.

 

Conflict of interest

The author declares no conflict of interest regarding the publication of this paper.

 

Ethical approval

Not applicable

 

Availability of data and material

The datasets analyzed during the current study are available upon request with no restriction.

 

Consent for publication

This manuscript has been approved for publication by all authors.

1. Villoslada P. Biomarkers for multiple sclerosis. Drug News Perspect. 2010;23(9):585-95.
https://doi.org/10.1358/dnp.2010.23.9.1472300
PMid:21152453
 
2. Ferrè L, Clarelli F, Pignolet B, Mascia E, Frasca M, Santoro S, et al. Combining Clinical and Genetic Data to Predict Response to Fingolimod Treatment in Relapsing Remitting Multiple Sclerosis Patients: A Precision Medicine Approach. J Pers Med. 2023;13(1).
https://doi.org/10.3390/jpm13010122
PMid:36675783 PMCid:PMC9861774
 
3. Dong X. Current Strategies for Brain Drug Delivery. Theranostics. 2018;8(6):1481-93.
https://doi.org/10.7150/thno.21254
PMid:29556336 PMCid:PMC5858162
 
4. Manglani HR, Healy BC, Vranceanu AM. Demand with low supply: A pipeline for personalized integrative medicine in multiple sclerosis. Mult Scler Relat Disord. 2022;58:103493.
https://doi.org/10.1016/j.msard.2022.103493
PMid:35030367
 
5. Dillenseger A, Weidemann ML, Trentzsch K, Inojosa H, Haase R, Schriefer D, et al. Digital Biomarkers in Multiple Sclerosis. Brain Sci. 2021;11(11).
https://doi.org/10.3390/brainsci11111519
PMid:34827518 PMCid:PMC8615428
 
6. Voigt I, Inojosa H, Dillenseger A, Haase R, Akgün K, Ziemssen T. Digital Twins for Multiple Sclerosis. Front Immunol. 2021;12:669811.
https://doi.org/10.3389/fimmu.2021.669811
PMid:34012452 PMCid:PMC8128142
 
7. Waliño-Paniagua CN, Gómez-Calero C, Jiménez-Trujillo MI, Aguirre-Tejedor L, Bermejo-Franco A, Ortiz-Gutiérrez RM, et al. Effects of a Game-Based Virtual Reality Video Capture Training Program Plus Occupational Therapy on Manual Dexterity in Patients with Multiple Sclerosis: A Randomized Controlled Trial. J Healthc Eng. 2019;2019:9780587.
https://doi.org/10.1155/2019/9780587
PMid:31178989 PMCid:PMC6501239
 
8. Tao L, Wang Q, Liu D, Wang J, Zhu Z, Feng L. Eye tracking metrics to screen and assess cognitive impairment in patients with neurological disorders. Neurol Sci. 2020;41(7):1697-704.
https://doi.org/10.1007/s10072-020-04310-y
PMid:32125540
 
9. Baulina N, Kiselev I, Favorova O. Imprinted Genes and Multiple Sclerosis: What Do We Know? Int J Mol Sci. 2021;22(3).
https://doi.org/10.3390/ijms22031346
PMid:33572862 PMCid:PMC7866243
 
10. Bonnechère B. Integrating Rehabilomics into the Multi-Omics Approach in the Management of Multiple Sclerosis: The Way for Precision Medicine? Genes (Basel). 2022;14(1).
https://doi.org/10.3390/genes14010063
PMid:36672802 PMCid:PMC9858788
 
11. Del Boccio P, Rossi C, di Ioia M, Cicalini I, Sacchetta P, Pieragostino D. Integration of metabolomics and proteomics in multiple sclerosis: From biomarkers discovery to personalized medicine. Proteomics Clin Appl. 2016;10(4):470-84.
https://doi.org/10.1002/prca.201500083
PMid:27061322
 
12. Rispoli MG, D'Apolito M, Pozzilli V, Tomassini V. Lessons from immunotherapies in multiple sclerosis. Handb Clin Neurol. 2023;193:293-311.
https://doi.org/10.1016/B978-0-323-85555-6.00013-8
PMid:36803817
 
13. Can Demirdöğen B. A literature review of biosensors for multiple sclerosis: Towards personalized medicine and point-of-care testing. Mult Scler Relat Disord. 2021;48:102675.
https://doi.org/10.1016/j.msard.2020.102675
PMid:33326907
 
14. Milošević M, Arsić A, Cvetković Z, Vučić V. Memorable Food: Fighting Age-Related Neurodegeneration by Precision Nutrition. Front Nutr. 2021;8:688086.
https://doi.org/10.3389/fnut.2021.688086
PMid:34422879 PMCid:PMC8374314
 
15. Andrzejewska A, Dabrowska S, Lukomska B, Janowski M. Mesenchymal Stem Cells for Neurological Disorders. Adv Sci (Weinh). 2021;8(7):2002944.
https://doi.org/10.1002/advs.202002944
PMid:33854883 PMCid:PMC8024997
 
16. Wiese MD, Suppiah V, O'Doherty C. Metabolic and safety issues for multiple sclerosis pharmacotherapy--opportunities for personalised medicine. Expert Opin Drug Metab Toxicol. 2014;10(8):1145-59.
https://doi.org/10.1517/17425255.2014.925880
PMid:24910969
 
17. Thompson AJ, Baranzini SE, Geurts J, Hemmer B, Ciccarelli O. Multiple sclerosis. Lancet. 2018;391(10130):1622-36.
https://doi.org/10.1016/S0140-6736(18)30481-1
PMid:29576504
 
18. Diakou I, Papakonstantinou E, Papageorgiou L, Pierouli K, Dragoumani K, Spandidos DA, et al. Multiple sclerosis and computational biology (Review). Biomed Rep. 2022;17(6):96.
https://doi.org/10.3892/br.2022.1579
PMid:36382258 PMCid:PMC9634047
 
19. Markowitz CE. Multiple sclerosis update. Am J Manag Care. 2013;19(16 Suppl):s294-300.
 
20. Oh J, Vidal-Jordana A, Montalban X. Multiple sclerosis: clinical aspects. Curr Opin Neurol. 2018;31(6):752-9.
https://doi.org/10.1097/WCO.0000000000000622
PMid:30300239
 
21. Ziemssen T, Kern R, Thomas K. Multiple sclerosis: clinical profiling and data collection as prerequisite for personalized medicine approach. BMC Neurol. 2016;16:124.
https://doi.org/10.1186/s12883-016-0639-7
PMid:27484848 PMCid:PMC4971685
 
22. Engelhardt B, Comabella M, Chan A. Multiple sclerosis: Immunopathological heterogeneity and its implications. Eur J Immunol. 2022;52(6):869-81.
https://doi.org/10.1002/eji.202149757
PMid:35476319 PMCid:PMC9324211
 
23. Pathak N, Vimal SK, Tandon I, Agrawal L, Hongyi C, Bhattacharyya S. Neurodegenerative Disorders of Alzheimer, Parkinsonism, Amyotrophic Lateral Sclerosis and Multiple Sclerosis: An Early Diagnostic Approach for Precision Treatment. Metab Brain Dis. 2022;37(1):67-104.
https://doi.org/10.1007/s11011-021-00800-w
PMid:34719771
 
24. Lejbkowicz I, Caspi O, Miller A. Participatory medicine and patient empowerment towards personalized healthcare in multiple sclerosis. Expert Rev Neurother. 2012;12(3):343-52.
https://doi.org/10.1586/ern.11.161
PMid:22364333
 
25. Luo C, Ye WR, Shi W, Yin P, Chen C, He YB, et al. Perfect match: mTOR inhibitors and tuberous sclerosis complex. Orphanet J Rare Dis. 2022;17(1):106.
https://doi.org/10.1186/s13023-022-02266-0
PMid:35246210 PMCid:PMC8895788
 
26. Gafson A, Craner MJ, Matthews PM. Personalised medicine for multiple sclerosis care. Mult Scler. 2017;23(3):362-9.
https://doi.org/10.1177/1352458516672017
PMid:27672137
 
27. Villoslada P. Personalized medicine for multiple sclerosis: How to integrate neurofilament light chain levels in the decision? Mult Scler. 2021;27(13):1967-9.
https://doi.org/10.1177/13524585211049552
PMid:34612731
 
28. Giovannoni G. Personalized medicine in multiple sclerosis. Neurodegener Dis Manag. 2017;7(6s):13-7.
https://doi.org/10.2217/nmt-2017-0035
PMid:29143582
 
29. Derfuss T. Personalized medicine in multiple sclerosis: hope or reality? BMC Med. 2012;10:116.
https://doi.org/10.1186/1741-7015-10-116
PMid:23035757 PMCid:PMC3523020
 
30. Henschke A, Desborough J, Parkinson A, Brunoro C, Fanning V, Lueck C, et al. Personalizing Medicine and Technologies to Address the Experiences and Needs of People with Multiple Sclerosis. J Pers Med. 2021;11(8).
https://doi.org/10.3390/jpm11080791
PMid:34442434 PMCid:PMC8401762
 
31. Hansen MR, Okuda DT. Precision medicine for multiple sclerosis promotes preventative medicine. Ann N Y Acad Sci. 2018;1420(1):62-71.
https://doi.org/10.1111/nyas.13846
PMid:29878402
 
32. Toro-Domínguez D, Alarcón-Riquelme ME. Precision medicine in autoimmune diseases: fact or fiction. Rheumatology (Oxford). 2021;60(9):3977-85.
https://doi.org/10.1093/rheumatology/keab448
PMid:34003926
 
33. Gourraud PA, Henry RG, Cree BA, Crane JC, Lizee A, Olson MP, et al. Precision medicine in chronic disease management: The multiple sclerosis BioScreen. Ann Neurol. 2014;76(5):633-42.
https://doi.org/10.1002/ana.24282
PMid:25263997 PMCid:PMC4214886
 
34. Comabella M, Sastre-Garriga J, Montalban X. Precision medicine in multiple sclerosis: biomarkers for diagnosis, prognosis, and treatment response. Curr Opin Neurol. 2016;29(3):254-62.
https://doi.org/10.1097/WCO.0000000000000336
PMid:27075495
 
35. Poutiainen P, Jaronen M, Quintana FJ, Brownell AL. Precision Medicine in Multiple Sclerosis: Future of PET Imaging of Inflammation and Reactive Astrocytes. Front Mol Neurosci. 2016;9:85.
https://doi.org/10.3389/fnmol.2016.00085
PMid:27695400 PMCid:PMC5023680
 
36. Gavriilaki M, Kimiskidis VK, Gavriilaki E. Precision Medicine in Neurology: The Inspirational Paradigm of Complement Therapeutics. Pharmaceuticals (Basel). 2020;13(11).
https://doi.org/10.3390/ph13110341
PMid:33114553 PMCid:PMC7693884
 
37. Bose G, Freedman MS. Precision medicine in the multiple sclerosis clinic: Selecting the right patient for the right treatment. Mult Scler. 2020;26(5):540-7.
https://doi.org/10.1177/1352458519887324
PMid:31965903
 
38. Schleimer E, Pearce J, Barnecut A, Rowles W, Lizee A, Klein A, et al. A Precision Medicine Tool for Patients With Multiple Sclerosis (the Open MS BioScreen): Human-Centered Design and Development. J Med Internet Res. 2020;22(7):e15605.
https://doi.org/10.2196/15605
PMid:32628124 PMCid:PMC7381029
 
39. Havas J, Leray E, Rollot F, Casey R, Michel L, Lejeune F, et al. Predictive medicine in multiple sclerosis: A systematic review. Mult Scler Relat Disord. 2020;40:101928.
https://doi.org/10.1016/j.msard.2020.101928
PMid:32004856
 
40. Rotstein D, Montalban X. Reaching an evidence-based prognosis for personalized treatment of multiple sclerosis. Nat Rev Neurol. 2019;15(5):287-300.
https://doi.org/10.1038/s41582-019-0170-8
PMid:30940920
 
41. Kayser C, Dutra LA, Dos Reis-Neto ET, Castro CHM, Fritzler MJ, Andrade LEC. The Role of Autoantibody Testing in Modern Personalized Medicine. Clin Rev Allergy Immunol. 2022;63(2):251-88.
https://doi.org/10.1007/s12016-021-08918-6
PMid:35244870
 
42. Kes VB, Cesarik M, Matovina LZ, Zavoreo I, Corić L, Drnasin S, et al. The role of complementary and alternative medicine in therapy of multiple sclerosis. Acta Clin Croat. 2013;52(4):464-71.
 
43. Schinocca C, Rizzo C, Fasano S, Grasso G, La Barbera L, Ciccia F, et al. Role of the IL-23/IL-17 Pathway in Rheumatic Diseases: An Overview. Front Immunol. 2021;12:637829.
https://doi.org/10.3389/fimmu.2021.637829
PMid:33692806 PMCid:PMC7937623
 
44. Fox RJ. Tissue Markers for Acute Multiple Sclerosis Treatment Response-A Step Toward Personalized Medicine. JAMA Neurol. 2018;75(4):406-7.
https://doi.org/10.1001/jamaneurol.2017.4850
PMid:29404560
 
45. Pitt D, Lo CH, Gauthier SA, Hickman RA, Longbrake E, Airas LM, et al. Toward Precision Phenotyping of Multiple Sclerosis. Neurol Neuroimmunol Neuroinflamm. 2022;9(6).
https://doi.org/10.1212/NXI.0000000000200025
PMid:36041861 PMCid:PMC9427000
 
46. Krysko KM, Bove R, Dobson R, Jokubaitis V, Hellwig K. Treatment of Women with Multiple Sclerosis Planning Pregnancy. Curr Treat Options Neurol. 2021;23(4):11.
https://doi.org/10.1007/s11940-021-00666-4
PMid:33814892 PMCid:PMC8008016
Volume 2, Issue 1
April 2023
Pages 30-34
  • Receive Date: 07 March 2023
  • Accept Date: 24 April 2023