From "one size fits all" to personalized therapy

Multiple sclerosis is also called a disease with a thousand faces, because no two courses are alike. Early intervention is needed to preserve brain and spinal cord tissue. This is because even in the early stages, mental well-being, quality of life and ability to work, among other things, can be significantly impaired. The goal is personalized medicine that focuses on individual concerns.

Hippocrates already knew that it is much more important which patient has the disease than which disease the patient has. Nevertheless, for many years the principle of “one size fits all” was applied and multiple sclerosis (MS) was regarded as a target, as Prof. Tjalf Ziemssen, MD, Dresden (D), pointed out. The foundation of evidence-based medicine also does not leave much room for individual decision-making. This is because a statistical approach requires large numbers to produce representative results. However, MS is an individually very variable disease with different courses. Therefore, the therapy should actually be adapted to this variability, i.e., personalized, according to the expert. However, the disease is difficult to monitor and predict. This makes it all the more important in daily practice to keep the peculiarities of each patient in mind and to phenotype them by measurement (Fig. 1).

Phenotypes in focus

Lublin MS phenotyping has taken a first step in the right direction by distinguishing the disease into active and non-active patients. However, against the backdrop of the many therapeutic options available today, this is no longer sufficient. A much more sensitive system is needed to capture sub-clinical markers in addition to the obvious clinical signs, such as disability progression and relapses, among others. These include, for example, MRI pathology, brain atrophy, and neurofilament levels. “We need to try to collect data in clinical reality,” Ziemssen affirmed.

Preserve the neurological reserve

The top priority is to maintain “brain health” (Fig. 2). Any delay in diagnosis and optimal therapy increases the risk of unnecessary loss of physical and cognitive functions for the individual patient. Overall, there are three main recommendations to maintain neurological reserve or brain health:

Delays in diagnosis and therapy initiation or optimization should be avoided,
Disease activity should be monitored in detail and closely in order to implement a so-called treat to a target therapy concept,
Robust scientific evidence from Real World data will be generated that can be used to optimize the treatment of individual MS patients.

Under these conditions, it is possible to personalize MS therapy, the expert is certain. There is no contradiction in collecting large amounts of data in order to provide individualized treatment. This is the only way to observe how different patients respond to different therapies and then generate the appropriate treatment with the help of statistical methods. “I am sure that personalized therapy is what we will be able to offer our patients as standard in a few years,” Ziemssen concluded.

Source: Alzheimer’s Association International Conference (AAIC) 2020

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