Giovannoni Gavin
Blizard Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London E1 2AT, UK.
Neurodegener Dis Manag. 2017 Nov;7(6s):13-17. doi: 10.2217/nmt-2017-0035.
The therapeutic approach in multiple sclerosis (MS) requires a personalized medicine frame beyond the precision medicine concept, which is not currently implementable due to the lack of robust biomarkers and detailed understanding of MS pathogenesis. Personalized medicine demands a patient-focused approach, with disease taxonomy informed by characterization of pathophysiological processes. Important questions concerning MS taxonomy are: when does MS begin? When does the progressive phase begin? Is MS really two or three diseases? Does a therapeutic window truly exist? Newer evidence points to a disease spectrum and a therapeutic lag of several years for benefits to be observed from disease-modifying therapy. For personalized treatment, it is important to ascertain disease stage and any worsening of focal inflammatory lesions over time.
多发性硬化症（MS）的治疗方法需要超越精准医学概念的个性化医疗框架，由于缺乏可靠的生物标志物以及对MS发病机制的详细了解，目前该框架尚无法实施。个性化医疗需要以患者为中心的方法，疾病分类需依据病理生理过程的特征来确定。关于MS分类的重要问题包括：MS何时开始？进展期何时开始？MS真的是两种或三种疾病吗？治疗窗口真的存在吗？最新证据表明存在疾病谱以及疾病修饰治疗需数年才能观察到疗效的治疗延迟。对于个性化治疗而言，确定疾病阶段以及局灶性炎症性病变随时间的任何恶化情况非常重要。
