The article discusses the personalized use of disease-modifying therapies (DMTs) in multiple sclerosis (MS), emphasizing the importance of individualized treatment based on patient characteristics. MS is a central nervous system (CNS) inflammatory demyelinating disease that affects millions of young patients globally. Over the past two decades, more than ten DMTs have become available, offering varying levels of efficacy, administration routes, and adverse effects. The heterogeneity of MS patients, including clinical features, lesion load, and response to DMTs, necessitates a tailored approach to treatment. Shared decision-making with patients is advocated, considering their preferences and expectations. The review highlights the role of T cells, B cells, and myeloid cells in MS pathophysiology, with T cells playing a central role in immune responses, while B cells contribute to early T cell activation and CNS inflammation. Myeloid cells, including macrophages and microglia, are involved in inflammatory responses and neuroinflammation. The article also discusses the etiology, risk factors, and prognostic factors of MS, noting the importance of genetic and environmental factors. The review covers various DMTs, including low-efficacy therapies like interferon beta, glatiramer acetate, and teriflunomide, moderate-efficacy therapies such as dimethyl fumarate, and high-efficacy therapies like natalizumab, alemtuzumab, and B-cell-depleting agents. Each DMT has distinct mechanisms, efficacy, and safety profiles, with considerations for pregnancy, adverse effects, and long-term use. The article emphasizes the importance of individualized treatment decisions, considering patient-specific factors and the potential benefits and risks of each therapy. The review concludes that personalized treatment approaches are essential for optimizing outcomes in MS patients.The article discusses the personalized use of disease-modifying therapies (DMTs) in multiple sclerosis (MS), emphasizing the importance of individualized treatment based on patient characteristics. MS is a central nervous system (CNS) inflammatory demyelinating disease that affects millions of young patients globally. Over the past two decades, more than ten DMTs have become available, offering varying levels of efficacy, administration routes, and adverse effects. The heterogeneity of MS patients, including clinical features, lesion load, and response to DMTs, necessitates a tailored approach to treatment. Shared decision-making with patients is advocated, considering their preferences and expectations. The review highlights the role of T cells, B cells, and myeloid cells in MS pathophysiology, with T cells playing a central role in immune responses, while B cells contribute to early T cell activation and CNS inflammation. Myeloid cells, including macrophages and microglia, are involved in inflammatory responses and neuroinflammation. The article also discusses the etiology, risk factors, and prognostic factors of MS, noting the importance of genetic and environmental factors. The review covers various DMTs, including low-efficacy therapies like interferon beta, glatiramer acetate, and teriflunomide, moderate-efficacy therapies such as dimethyl fumarate, and high-efficacy therapies like natalizumab, alemtuzumab, and B-cell-depleting agents. Each DMT has distinct mechanisms, efficacy, and safety profiles, with considerations for pregnancy, adverse effects, and long-term use. The article emphasizes the importance of individualized treatment decisions, considering patient-specific factors and the potential benefits and risks of each therapy. The review concludes that personalized treatment approaches are essential for optimizing outcomes in MS patients.