# Personalized Use of Disease-Modifying Therapies in Multiple Sclerosis

**Authors:** Chi-Yan Lee, Koon-Ho Chan

PMC · DOI: 10.3390/pharmaceutics16010120 · 2024-01-17

## TL;DR

This paper reviews how to personalize disease-modifying therapies for multiple sclerosis patients based on individual factors and shared decision-making.

## Contribution

The paper provides an updated review on personalizing DMT use in relapsing MS patients through shared decision-making.

## Key findings

- More than ten disease-modifying drugs are now available for multiple sclerosis.
- DMTs vary in efficacy, administration routes, and risks, requiring careful personalized use.
- Shared decision-making is advocated to align with patient preferences and understanding of DMT benefits and risks.

## Abstract

Multiple sclerosis is an important neurological disease affecting millions of young patients globally. It is encouraging that more than ten disease-modifying drugs became available for use in the past two decades. These disease-modifying therapies (DMTs) have different levels of efficacy, routes of administration, adverse effect profiles and concerns for pregnancy. Much knowledge and caution are needed for their appropriate use in MS patients who are heterogeneous in clinical features and severity, lesion load on magnetic resonance imaging and response to DMT. We aim for an updated review of the concept of personalization in the use of DMT for relapsing MS patients. Shared decision making with consideration for the preference and expectation of patients who understand the potential efficacy/benefits and risks of DMT is advocated.

## Linked entities

- **Diseases:** multiple sclerosis (MONDO:0005301)

## Full-text entities

- **Genes:** S1PR1 (sphingosine-1-phosphate receptor 1) [NCBI Gene 1901] {aka CD363, CHEDG1, D1S3362, ECGF1, EDG-1, EDG1}, S1PR5 (sphingosine-1-phosphate receptor 5) [NCBI Gene 53637] {aka EDG8, Edg-8, S1P5, SPPR-1, SPPR-2}, GLA (galactosidase alpha) [NCBI Gene 2717] {aka GALA}, IL10 (interleukin 10) [NCBI Gene 3586] {aka CSIF, GVHDS, IL-10, IL10A, TGIF}, CSF2 (colony stimulating factor 2) [NCBI Gene 1437] {aka CSF, GMCSF}, MBP (myelin basic protein) [NCBI Gene 4155], CD4 (CD4 molecule) [NCBI Gene 920] {aka CD4mut, IMD79, Leu-3, OKT4D, T4}, NFE2L2 (NFE2 like bZIP transcription factor 2) [NCBI Gene 4780] {aka IMDDHH, NRF2, Nrf-2}, LTA (lymphotoxin alpha) [NCBI Gene 4049] {aka LT, TNFB, TNFSF1, TNLG1E}, IFNB1 (interferon beta 1) [NCBI Gene 3456] {aka IFB, IFF, IFN-beta, IFNB}, KRT20 (keratin 20) [NCBI Gene 54474] {aka CD20, CK-20, CK20, K20, KRT21}, CYP2C9 (cytochrome P450 family 2 subfamily C member 9) [NCBI Gene 1559] {aka CPC9, CYP2C, CYP2C10, CYPIIC9, P450-2C9, P450IIC9}, CD8A (CD8 subunit alpha) [NCBI Gene 925] {aka CD8, CD8alpha, IMD116, Leu2, p32}, IL6 (interleukin 6) [NCBI Gene 3569] {aka BSF-2, BSF2, CDF, HGF, HSF, IFN-beta-2}, CD52 (CD52 molecule) [NCBI Gene 1043] {aka CDW52, EDDM5, HE5}, TNF (tumor necrosis factor) [NCBI Gene 7124] {aka DIF, IMD127, TNF-alpha, TNFA, TNFSF2, TNLG1F}, HEPACAM (hepatic and glial cell adhesion molecule) [NCBI Gene 220296] {aka GlialCAM, MLC2A, MLC2B}, S1PR3 (sphingosine-1-phosphate receptor 3) [NCBI Gene 1903] {aka C9orf108, C9orf47, EDG-3, EDG3, LPB3, S1P3}, VCAM1 (vascular cell adhesion molecule 1) [NCBI Gene 7412] {aka CD106, INCAM-100}, FOXP3 (forkhead box P3) [NCBI Gene 50943] {aka AIID, DIETER, IPEX, JM2, PIDX, XPID}
- **Diseases:** hepatitis C (MESH:D019698), fetal loss (MESH:D005315), flu-like symptoms (MESH:D007251), optic neuritis (MESH:D009902), gliosis (MESH:D005911), herpes infections (MESH:D007239), disability (MESH:D009069), bone marrow suppression (MESH:D001855), fatigue (MESH:D005221), long QT (MESH:D008133), CIS (MESH:D059466), T2 lesion (MESH:C535434), cord lesions (MESH:D013118), Anti-herpes virus (MESH:D020031), BVL (MESH:D001927), hot flashes (MESH:D019584), pathologies (MESH:D005598), injury to people or property (MESH:C000719191), teratogenic (MESH:C535542), candidiasis (MESH:D002177), Gastrointestinal disturbances (MESH:D005767), listeriosis (MESH:D008088), diarrhea (MESH:D003967), autoimmune and neurodegenerative diseases (MESH:D019636), NEDA-3 (MESH:C537153), myalgia (MESH:D063806), peripheral neuropathy (MESH:D010523), urinary tract infection (MESH:D014552), autoimmune conditions (MESH:D001327), nausea (MESH:D009325), varicella zoster virus (MESH:D000073618), SA (MESH:D013615), pneumocystis pneumonia (MESH:D011020), oligodendrocyte loss (MESH:D056784), anti-glomerular basement membrane disease (MESH:D019867), nasopharyngitis (MESH:D009304), T cell abnormalities (MESH:C536780), basal cell carcinoma of the skin (MESH:D002280), arrhythmia (MESH:D001145), axonal injury (MESH:D001480), opportunistic infections (MESH:D009894), lymphopenia (MESH:D008231), brain atrophy (MESH:C566985), headache (MESH:D006261), bradycardia (MESH:D001919), lesions (MESH:D009059), CNS inflammation (MESH:D007249), HET (MESH:D016609), aspergillosis (MESH:D001228), cryptococcus infection (MESH:D003453), Macular edema (MESH:D008269), II (MESH:C537730), hair loss (MESH:D000505), ASCLEPIOS I (MESH:D006969), fever (MESH:D005334), flushing (MESH:D005483), obesity (MESH:D009765), inflammatory demyelination (MESH:D020277), tuberculosis (MESH:D014376), PPMS (MESH:D020528)
- **Chemicals:** loperamide (MESH:D008139), methylprednisolone (MESH:D008775), amino acids (MESH:D000596), Ozanimod (MESH:C000607776), Cladribine (MESH:D017338), creatinine (MESH:D003404), Ponesimod (MESH:C550169), CDP (MESH:D003565), pyrimidine (MESH:C030986), mitoxantrone (MESH:D008942), Ocrelizumab (MESH:C533411), ROS (MESH:D017382), fumaric acid (MESH:C032005), Fingolimod (MESH:D000068876), Rituximab (MESH:D000069283), Natalizumab (MESH:D000069442), cholestyramine (MESH:D002792), GA (MESH:D000068717), gadolinium (MESH:D005682), TF (MESH:C527525), vitamin D (MESH:D014807), DMF (MESH:D000069462), Alemtuzumab (MESH:D000074323), Ofatumumab (MESH:C527517), alcohol (MESH:D000438), Monomethyl fumarate (MESH:C509058), aspirin (MESH:D001241), Siponimod (MESH:C578989), activated charcoal (MESH:D002606), caffeine (MESH:D002110), S1P (MESH:C060506), DMT (-)
- **Species:** Human alphaherpesvirus 3 (Varicella-zoster virus, no rank) [taxon 10335], Human immunodeficiency virus (species) [taxon 12721], Homo sapiens (human, species) [taxon 9606], Nicotiana tabacum (American tobacco, species) [taxon 4097], Polyomavirus sp. (species) [taxon 36362]

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Source: https://tomesphere.com/paper/PMC10820407