Benjamin M. Segal, MD

“As we age, there is a systemic, low-grade chronic inflammation and the release of a lot of pro-inflammatory molecules from macrophages throughout the body. Some of these pro-inflammatory molecules may cross the blood-brain barrier and cause this widespread microglial activation that we see in progressive MS.”

Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS)

, February 25-27, Benjamin Segal, MD, addressed the committee in the form of the Kenneth P. Johnson Memorial Lecture. For his topic of choice, he spoke on the current overall understanding of and differences between the relapsing and progressive forms of multiple sclerosis (MS).

This lecture featured, of course, how these changes in disease often require parallel changes in the treatment approach. Physicians such as Segal often engage with patients with inactive progressive MS about possibly discontinuing treatment with disease-modifying therapy as their disease continues on that course. Additionally, he offered his insight into how progressive disease differs from relapsing MS on a molecular level, postulating about the potential cause of blood-brain barrier breakdown in early disease.

, Segal, who is the chair of the Department of Neurology and the director of the Neuroscience Research Institute at The Ohio State University, spoke to his major take-home messages from the talk regarding the current understanding of the phases of the disease.

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The chair of the Department of Neurology and the director of the Neuroscience Research Institute at The Ohio State University discussed the takeaways from his lecture at ACTRIMS Forum 2021.

Differences Between Progressive and Relapsing MS: Benjamin Segal, MD

“When patients are really far into the progressive phase, these drugs are not effective, in general. Often, this leads to [this] question: if someone has progressive MS and has not had a clinical attack or an enhancing lesion for many years, but they’re still on disease-modifying therapy carried over from their relapsing phase, do you discontinue it?”

There are currently a small number of disease-modifying therapies (DMTs) for the progressive phase of multiple sclerosis (MS), such as siponimod (Mayzent; Novartis) and ocrelizumab (Ocrevus; Genentech), making progressive disease types—primary and secondary—limited in treatment. Additionally, many patients who have inactive progressive disease experience little benefit from their DMT.

This can often lead MS specialists like Benjamin Segal, MD, to have conversations with patients in their clinical care about possibly choosing to discontinue their treatment. This, he said, is followed by a period of close monitoring to ensure there are no adverse reactions—a rare occurrence in his experience. Ultimately, it is a step he’s taken with hundreds of patients.

The difference between the relapsing and progressive stages of MS and the inner workings of the transition between them was the chosen topic of this year’s Kenneth P. Johnson Memorial Lecture at the 

, February 25-27, by Segal, who is the chair of the Department of Neurology and the director of the Neuroscience Research Institute at The Ohio State University. He additionally discussed how these differences relate to the current state of treatment for MS.

 spoke with Segal in an interview. He offered his insight on discontinuing treatment and shared a summary of the current understanding of the changing neuroinflammatory response in individuals with MS.

The chair of the Department of Neurology and the director of the Neuroscience Research Institute at The Ohio State University also offered his insight on discontinuing treatment in progressive MS.

The Changing Neuroinflammatory Response in Progressive MS: Benjamin Segal, MD

“What happens in terms of the destructive immune response that transforms the clinical course from a relapsing-remitting pattern to a gradual, progressive accumulation of disability? We don’t really have a good grasp on that.”

Multiple sclerosis (MS) can affect patients in a number of ways, but how the disease presents can change drastically over the course of a patient’s life. This, in turn, affects the way in which physicians must approach its treatment. Many disease-modifying therapies (DMTs) used to treat relapsing-remitting MS are, as Benjamin Segal, MD, puts it, “rendered ineffective in large part” once a patient transitions to progressive MS.

The difference between these states of disease and the inner workings of this transition process was the chosen topic of this year’s Kenneth P. Johnson Memorial Lecture at the 

To find out more about the talk and why he chose to focus on this topic, 

 spoke with Segal in an interview. He offered his perspective on this transition from relapsing-remitting to progressive disease, and how this ultimately impacts treatment.

The chair of the Department of Neurology and the director of the Neuroscience Research Institute at The Ohio State University discussed his lecture at ACTRIMS Forum 2021.

The Kenneth P. Johnson Memorial Lecture and the Clinical Course of MS: Benjamin Segal, MD

“A big issue that we addressed in this meeting that I think is going to continue being a subject of discussion is: during the beginning stages of MS, how aggressive should you be in disease-modifying therapy?”

One of the leading topics of conversation in the multiple sclerosis (MS) community has been the induction versus escalation therapeutic approach. On one hand, induction: the thought that high-efficacy therapy should be started as soon as possible; and on the other, escalation: the thought that efficacy can be escalated to meet the needs of the patient along their disease progression and activity.

At this year’s joint ECTRIMS-ACTRIMS meeting, MS Virtual 2020, this conversation continued. Benjamin M. Segal, MD, chair, Department of Neurology, and director, Neuroscience Research Institute, The Ohio State University, offered 

 an overview of this debate in a recent interview. He discussed some of the pros and cons of each side of the conversation, and some anecdotal experience he’s had in treating patients.

Segal, who was the co-chair of the scientific program committee for MS Virtual 2020 and is the co-director of the Neurological Institute and The Stanley D. and Joan H. Ross Chair in Neuromodulation at Ohio State, also offered some insight into the literature that has been published comparing these philosophies, and what those findings suggest.

The chair of the department of neurology at The Ohio State University spoke to the ongoing conversation in MS about how aggressive to be with treatment early on.

Benjamin M. Segal, MD

Articles

Differences Between Progressive and Relapsing MS: Benjamin Segal, MD

The Changing Neuroinflammatory Response in Progressive MS: Benjamin Segal, MD

The Kenneth P. Johnson Memorial Lecture and the Clinical Course of MS: Benjamin Segal, MD

Benjamin M. Segal, MD: Escalation Versus Induction in MS