**5. Conclusions**

We conclude that diet plays an important role in the composition of the intestinal microbiota in MS patients and controls. In addition, intestinal dysbiosis, detected in RRMS patients receiving DMTs, could be involved in increased intestinal permeability and affect clinical response, future relapses, and disease progression in MS patients. Additional studies in patients with different forms of MS, using DMTs, in different populations are needed, and the future goal is to predict therapeutic responses based on individual microbiome analyses (personalized medicine) and propose dietary interventions and the use of probiotics or other microbiota modulators as adjuvant therapy to enhance the therapeutic efficacy of DMTs.

**Author Contributions:** Conceptualization, G.L.V.d.O.; data curation, F.P.P., A.Z.L., N.d.C.R., M.J.U., M.I.G., N.N.C.T., V.S.M., W.P.O., D.G.P., and G.L.V.d.O.; formal analysis, F.P.P., A.Z.L., V.S.M. and G.L.V.d.O.; funding acquisition, N.d.C.R., E.M.J. and G.L.V.d.O.; investigation, F.P.P., A.Z.L., N.d.C.R., M.J.U., M.I.G., V.S.M., and G.L.V.d.O.; methodology, F.P.P., A.Z.L., N.d.C.R., M.I.G., N.N.C.T., V.S.M., W.P.O.; D.G.P., and V.S.M.; project administration, E.G. and G.L.V.d.O.; resources, E.G. and G.L.V.d.O.; supervision, D.G.P., E.M.J., E.G. and G.L.V.d.O.; validation, D.G.P., E.G., G.L.V.d.O.; visualization, G.L.V.d.O.; writing—original draft, F.P.P., A.Z.L., and G.L.V.d.O.; writing—review and editing, E.G. and G.L.V.d.O. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research was funded by the Brazilian governmental agency, Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), gran<sup>t</sup> numbers #2016/50204-0, #2016/05062-2, #2017/04508-0, #2021/03866-5.

**Institutional Review Board Statement:** The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee on Human Research from the Barretos Educational Foundation (protocol code 1522.762/2016; 29 April 2016).

**Informed Consent Statement:** Informed consent was obtained from all subjects involved in the study.

**Conflicts of Interest:** The authors declare no conflict of interest.
