We would like to sincerely thank Wang and Geng 1 for their interest in our article, “Multiple Sclerosis in Morocco: Impact on Patients' Quality of Life,” 2 and for their constructive comments regarding future research directions and the management of multiple sclerosis (MS) in Morocco. We fully share their overarching goal of improving the quality of life of people living with MS, particularly in middle-income countries. First, we acknowledge the importance, as highlighted by Wang and Geng, of integrating objective clinical indicators such as the Expanded Disability Status Scale (EDSS) and treatment adherence with patient-reported quality-of-life data. In our cross-sectional study, we deliberately focused data collection on the physical and mental dimensions of quality of life using the MSQOL-54 instrument, in order to document, for the first time at a national level, the most affected domains and the main sociodemographic determinants (age, sex, relapsing–remitting vs. primary progressive MS). We explicitly stated in the “Limitations” section that the absence of EDSS scores and detailed treatment information represented a constraint of the study, and we identified this as a priority for future research. Moreover, integrating the EDSS was not feasible within the framework of this research, as this indicator requires a thorough neurological examination performed by specialists, whereas our study was conducted remotely with patients. We are currently collaborating with several neurology centers to implement a prospective protocol combining clinical data (EDSS, treatment duration and type, comorbidities) with MSQOL-54 scores, precisely to address the need highlighted by Wang and Geng. With regard to cultural and social determinants, our study already points to several key contextual factors, including the predominance of young women, the high level of education, the substantial proportion of unemployment, and, most importantly, the lack of medical insurance for more than half of the patients. These elements reflect major socioeconomic and structural constraints specific to the Moroccan context. We fully agree, however, that caregiver burden and the use of traditional medicine are central features of the local care culture that were not measured in our online survey, mainly to limit questionnaire length and maximize response rate. These aspects will be examined in a complementary qualitative component (semi-structured interviews with patients and caregivers) that is currently being prepared in collaboration with the Moroccan Federation of MS Associations. From a clinical and public health perspective, we also concur with the proposal to develop age- and phenotype-stratified interventions. Our findings clearly show a marked decline in physical and mental scores after the age of 47 years, as well as substantially lower quality-of-life scores among patients with primary progressive MS compared with those with relapsing–remitting MS. In the Discussion section of our original article, we have already suggested prioritizing these subgroups for rehabilitation programs, psychosocial support, and therapeutic education. The suggestion to leverage digital networks (particularly the WhatsApp groups used for recruitment) to implement digital self-management tools and remote consultations is in line with the initiatives we are exploring with patient associations. Finally, we wish to emphasize that the primary objective of our work was to provide a detailed and robust national snapshot of health-related quality of life in Moroccan patients with MS, using a validated instrument (MSQOL-54) in a multicenter sample, and to identify the main sociodemographic determinants, which explain approximately 40% of the variance in quality-of-life scores. The extensions proposed by Wang and Geng (systematic integration of clinical data, in-depth exploration of caregiver burden and traditional medicine use, and operationalization of telemedicine programs and context-adapted interventions) constitute a logical continuation of this first step. We once again thank the authors for their pertinent suggestions, which help enrich the scientific discussion on the quality of life of patients with MS in Morocco, and we hope that our future work will address the issues they have raised. Rachid Lotfi: conception of the response, critical interpretation of the comments, drafting and revision of the manuscript. Hind Bel Amgharia and Sami Ennaciri: contribution to interpretation in relation to clinical aspects (EDSS, treatments), critical revision for important intellectual content. Mourad Chikhaoui, Ahmed Chetoui, and Jaouad Elkhalladi: contribution to methodological and public health aspects, critical revision for important intellectual content. Fatiha Chigr: supervision, validation of the arguments regarding future research directions and health system implications, final approval of the version to be submitted. Approval of the research protocol: The study protocol was approved by the Moroccan Ministry of Health (Ref. 8366-3/3/2021) and by an institutional ethics committee (Approval No. FST/BEL/2018/15). All procedures complied with institutional and national ethical standards. All participants were adults who provided electronic informed consent after reading the study information; participation was voluntary and data were collected anonymously. The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.
Lotfi et al. (2026) studied this question.