Personalized medicine has been a mantra for some years but in many cases this is just a pipe-dream. Personalization means screening to do selection and this equates to cost. It also takes time. Any screening is typically borne by the manufacturer. e.g., who pays for the genomic testing for siponimod as peoples genetics determine the dose…Yep the company.
It has been reported that genetics can influence the efficacy of rituximab, but do the Scandi’s test for the genetics? You can give the drug and see if it works.
Who screens for anti-drug antibodies…yep essentially no-one but the assays are developed by the companies but they don’t want you to test as it may stop you using the drug. We use a drug where a significant proportion of people are not responding properly because of anti-drug antibodies. We could look for them and switch people onto drugs that are working better.
Do we consider regional genetics, which could be relevant for some places with a higher ethnic mix, as some genes that influence action of antibodies are more or less common in different races.
Reda MD, Siva A, Tahir Turanlı E. Genetic Influences on Disease-Modifying Therapy Response in Multiple Sclerosis: Current Insights and Future Directions. Balkan Med J. 2026;43(4):174-182.
Multiple sclerosis (MS) is a clinically and biologically heterogeneous, immune-mediated disease of the central nervous system, with substantial interindividual variability in disease course and response to disease-modifying therapies (DMTs). Over the past three decades, the MS therapeutic landscape has expanded considerably; however, treatment selection and switching remain guided primarily by clinical phenotype and imaging findings rather than molecular predictors of response. Despite extensive clinical trial evidence, prospectively identifying responders and non-responders to specific DMTs remains challenging. Genetic variability appears to influence differences in treatment efficacy, tolerability, and long-term outcomes in people with MS. Numerous candidate pharmacogenomic variants have been reported across interferon-β, glatiramer acetate, oral agents, and monoclonal antibodies; nevertheless, replication has been inconsistent, effect sizes are modest, and no genetic marker has yet been clinically validated for routine use. Consequently, pharmacogenomics is largely absent from current MS treatment algorithms. This review critically evaluates the existing pharmacogenomic literature across approved DMTs, highlighting reproducible findings, methodological limitations, and gaps that hinder clinical translation. We further discuss requirements for integrating pharmacogenomic markers into routine practice, emphasizing the need for large, multiethnic cohorts, standardized response definitions, and functional validation. Overall, these insights underscore both the potential and current limitations of pharmacogenomics in advancing precision medicine for MS.
Source: multiple-sclerosis-research.org