Defining Precision Medicine in Multiple Sclerosis

Precision medicine has become one of the most frequently used phrases in multiple sclerosis (MS), but its meaning in practice is far less settled. Fields such as oncology and rheumatology have long tailored treatment to a patient's disease subtype, biology, and individual circumstances. Neurology is still working out how to apply that approach. In MS, clinicians have long understood the disease as a spectrum rather than a set of distinct buckets. Even so, treatment has largely centered on suppressing inflammatory activity. As the range of available therapies expands, the question is no longer only which drug to use but how to match the right approach to the right patient at the right time.

To explore where the field stands, NeurologyLive^® partnered with Cleveland Clinic Neurological Institute on a new Roundtable series, Precision Medicine in Multiple Sclerosis: Advances & Unanswered Questions. The series features three clinicians from Cleveland Clinic's Mellen Center for Multiple Sclerosis Treatment and Research: Robert Bermel, MD, director of the Mellen Center; Marisa McGinley, DO, staff neurologist at the Mellen Center; and Rebecca Cebull, CNP, certified nurse practitioner at the Mellen Center. Across the series, the panel discusses biomarkers, advanced imaging, genetics, progression independent of relapse activity, and the gaps that remain between the promise of individualized care and everyday practice.

In this first episode, the panelists set a shared framework for the discussion by defining what precision medicine means in their own practice. McGinley describes it as weighing clinical factors, biological factors, and patient preferences together. She notes that MS care is only now gaining enough treatment diversity to individualize therapy across disease modification, rehabilitation, and symptom management. Bermel argues that much of what passes for precision medicine in MS today is really risk stratification. He compares clinicians to people deciding between a small battering ram and a big one when what they really need is a key cut for a specific door.

Cebull brings the patient perspective into the conversation. She explains that while care often starts with a traditional treat-to-target approach, the best therapy for a patient at diagnosis may not be the best one during family planning or a decade into their disease course. She also discusses how framing treatment as a fluid, evolving decision can ease patients' anxiety about feeling locked into a single immune therapy.