An Important but Limited Step Forward in Personalized Multiple Sclerosis Care

Treatment of relapsing-remitting multiple sclerosis (MS) in 2018 remains far from what can be described as personalized medicine, but an important initial step toward more personalized management of MS relapses has been achieved by researchers with University Medical Center Goettingen in Germany. So contends Cleveland Clinic neurologist Robert Fox, MD, in an editorial accompanying the German study published online by JAMA Neurology on February 5, 2018.

The retrospective cohort study evaluated the response to apheresis in relation to histopathologically defined immunopathological patterns of MS in 69 patients. As detailed in the published study report, the investigation provides the first evidence that short-term treatment response is related to the underlying inflammatory pathology within MS lesions.

“These observations further support the clinical relevance of MS lesion patterns and suggest that they may be useful in better understanding the heterogeneity in treatment response to MS therapies,” Dr. Fox writes in his editorial. He adds that the study is also helpful in providing further evidence supporting apheresis as short-term therapy for central nervous system demyelination.

At the same time, he notes, the study’s applicability is limited by the fact that all 69 patients underwent brain biopsy, which is highly unusual and invasive for MS patients in real-world practice. “The future of personalized medicine in MS requires markers that are easily obtained and measured,” Dr. Fox writes, citing fluid or imaging biomarkers as examples. Until such markers are identified, the tissue markers from the current study will remain only a research tool for the occasional patient who requires a brain biopsy.

The full Fox editorial is available here, and the Goettingen researchers’ study is available here.