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In SPMS, characterized by steady deterioration without acute attacks, treatment strategies often involve continuing or altering DMT used during the earlier RRMS phase, such as interferon beta, or considering immune-modulating agents, such as methotrexate, cyclophosphamide, or glucocorticoid pulses [142, 143]

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What distinguishes NAD+ from other metabolic cofactors is its remarkable versatility and central role in both metabolic and regulatory processes that extend far beyond energy production