Personalizing Treatment Decision-Making in Multiple Sclerosis Care: Constance V. Katsafanas, DO

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"If they have radiographic progression, even without symptoms, I tend to switch therapy. If they’re having new symptoms with radiographic progression, obviously you’re going to want to switch therapy."

Personalizing treatment for multiple sclerosis (MS) has become increasingly important given the disease's heterogeneity, which presents with variability in clinical presentation, progression, and treatment response in patients. Recent research highlights that optimizing therapy requires considering individual disease characteristics, biomarkers, and patient-specific factors to reduce disability progression. A prior review noted that the complexity of MS and the expanding number of available therapies necessitate individualized decision-making that balances efficacy, safety, and patient preferences.¹ Additionally, advances in biomarkers, imaging, and genetics are improving clinicians’ ability to tailor treatment strategies and more precisely predict the disease course.²

Emerging evidence further supports a shift toward precision medicine approaches in MS care, including the use of data-driven models and immune profiling to guide therapy selection. For example, recent studies have demonstrated that distinct immunological subtypes of MS can respond differently to therapies, reinforcing the need for personalized treatment strategies rather than a uniform approach.³ Similarly, research into AI-supported clinical decision tools suggests that integrating longitudinal patient data may enhance individualized treatment optimization and improve long-term outcomes. Together, these findings underscore that personalized care is not only clinically relevant but also increasingly feasible as the field evolves.

In honor of National MS Awareness Month, held each March, NeurologyLive^® spoke with MS expert Constance V. Katsafanas, DO, the director of the Neurology Residency Program at Marcus Neuroscience Institute, a part of Baptist Health South Florida. In the conversation, she discussed the critical role of individualized treatment selection in MS, while underscoring the need to align therapeutic choices with patient-specific circumstances. In cases of disease progression, she described monitoring both clinical and radiographic changes to guide treatment adjustments. Overall, she reinforced that a patient-centered, tailored approach, rather than a one-size-fits-all strategy, may be essential for optimizing care.

REFERENCES
1. Hernandez J. Multiple sclerosis treatment review for primary care providers. Nurse Pract. 2024;49(7):38-47. doi:10.1097/01.NPR.0000000000000202
2. Klotz L, Saraste M, Airas L, Kuhlmann T. Multiple sclerosis: 2024 update. Free Neuropathol. 2025 Jul 8;6:14. doi: 10.17879/freeneuropathology-2025-6762. PMID: 40636815; PMCID: PMC12238822.
3. Gross CC, Schulte-Mecklenbeck A, Steinberg OV, et al. Multiple sclerosis endophenotypes identified by high-dimensional blood signatures are associated with distinct disease trajectories. Sci Transl Med. 2024;16(740):eade8560. doi:10.1126/scitranslmed.ade8560
4. Klotz L, Saraste M, Airas L, Kuhlmann T. Multiple sclerosis: 2024 update. Free Neuropathol. 2025;6:14. Published 2025 Jul 8. doi:10.17879/freeneuropathology-2025-6762