The Road Ahead for Precision Medicine in Multiple Sclerosis

Unpredictability is one of the defining challenges of multiple sclerosis (MS). Patients often can’t know how their disease will behave, and clinicians can’t always know which therapy will work best or when to change course. Precision medicine aims to close that gap by drawing on each patient’s clinical history, imaging, biology, and preferences, so that treatment can be built around the individual rather than the average. The field has made real progress toward that goal, but many of its most important questions remain open.

NeurologyLive®’s Roundtable series Precision Medicine in Multiple Sclerosis: Advances & Unanswered Questions, produced in collaboration with Cleveland Clinic Neurological Institute, concludes with a look at those open questions. Throughout the series, Robert Bermel, MD, director of Cleveland Clinic’s Mellen Center for Multiple Sclerosis Treatment and Research; Marisa McGinley, DO, staff neurologist at the Mellen Center; and Rebecca Cebull, CNP, certified nurse practitioner at the Mellen Center, have examined biomarkers, advanced imaging, genetics, and PIRA. In this final installment, they consider what it will take to move the field forward.

Asked what research they would design, McGinley describes her team’s model for predicting the risk of renewed disease activity after a patient stops disease-modifying therapy, a key question for people aging on immunotherapy. Like an MRI, she explains, the tool is meant to inform shared decision-making, not dictate it, and she calls for trial designs built around individualized, data-driven treatment assignment.

Bermel sees a future in embedding tools like this in the electronic health record. Cebull notes that patients often want a concrete number to weigh their risks, recalling one who called MS “a fear disease” because he feared both undertreatment and overtreatment. Bermel closes the series by describing precision medicine as “the antidote to unpredictability.”