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Indeed, in more extreme cases with very aggressive inflammatory activity, a total reset of the patients immune system by autologous bone marrow transplantation has shown remarkable efficacy at stopping new relapses or MRI lesions and even modestly reversing clinical disability (Rush et al., 2019), though currently this aggressive intervention is recommended only for patients with very active inflammatory disease (Miller et al., 2021)

The cardinal rule of titration: the timeline is a floor, not a ceiling

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