The Future of Multiple Sclerosis Treatment


Ahmed Obeidat, MD, PhD; Benjamin Greenberg, MD; and Hesham Abboud, MD, share their hopes about the evolution of future mutiple sclerosis care and express their gratitude for the next generation of neurologists.

Ahmed Obeidat, MD, PhD: I'll ask you both, and we have limited time, but this is great and a very rich conversation. And Dr Abboud, I'll ask you for final words and the landscape of the future of MS. And how do you see the future of MS in general? I know you're hopefully on it and optimistic.

Hesham Abboud, MD: We are practicing different MS practice compared to the older generation of neurologists. And the new generation will practice different neurology in MS, in particular than what we're doing now. And we touched on things like immune tolerization, things like multi-target therapy that addresses the different possible etiologies and mechanisms of the disease. One of the things I'm looking forward to is the EBV vaccination trials looking at rates of MS in general. If we vaccinate against EBV, are we going to have less MS or maybe no MS in generations to come? I think this is very exciting. And I think the new generation of neurologists will deal more with this than us, but it's exciting to at least have something to look forward to.

Ahmed Obeidat, MD, PhD: Yes. Dr Greenberg, final words on the future of MS and optimistic view you have.

Benjamin Greenberg, MD: We would love to be put out of business.

Ahmed Obeidat, MD, PhD: Yes. We can do other things.

Benjamin Greenberg, MD: If the EBV vaccination worked, it would be one of the most wonderful things to live in a world where the 800,000 to a million people you referenced at the beginning, those numbers no longer existed. Moving towards prevention would be spectacular. It's interesting just thinking about the evolution. If we had been in a meeting 30 years ago, there wouldn't have been a single mention of B-cells in multiple sclerosis. It was a T-cell median disease.

Ahmed Obeidat, MD, PhD: Yes. That's what we were learning about in school.

Benjamin Greenberg, MD: And now one of the most, if not the, I don't know the actual data, but it's got to be at the top prescribed medications for MS is a B-cell or a group of B-cell depleting drugs. We went not just from not acknowledging a certain fundamental biology to acknowledging it, embracing it, and treating it. Thirty years from now, the conversation's going to be different than what we're having now. And only in good ways. What I tell my patients now when I meet them and talk about medications, one of their questions inevitably is, will I need to be on this medicine for the rest of my life? We're at a stage now where we can say to patients, no, you're picking a drug for right now, but your choices are going to be dramatically different, as we get 10, even 10, 15 years down the road, not 30. And it's bearing true as we look at every 10 years or the last 30, we've had novel different highly effective ways to intervene in this disease. And we spend a lot of time talking to our patients about the right now prevention and planning for a better future. And it's worth noting. And I know both of you, you do this, but we also want to encourage our patients to take care of themselves holistically, because since our drugs are so good at preventing MS from being an issue, we're running into the comorbid conditions down the line, becoming a bigger issue. And I remind my patients, just because you got one bad news diagnosis doesn't mean you can't get a second in the future. Exercise and diet and not smoking, all those things that we all advise are becoming critically important, because we are seeing more comorbid conditions develop over time as our patients are doing better.

Hesham Abboud, MD: And they can have a negative impact on MS as to response to treatment too.

Benjamin Greenberg, MD: We're going to be in a much better place. We will get to the personalized medicine place. And if I had to bet right now, and we'll play back the tape in 20 years, by that time, we will have something that is truly neuroprotective or restorative. It may not work for everybody, but at least for a subset of population, our population, we are going to see those agents come to fruition.

Ahmed Obeidat, MD, PhD: Yes, this is great. And this is very much providing hope for everyone. And I would like to thank you both today. It's been great and very rich and excellent conversation. I learned a lot. And thank you again and thank you for our audience.

Transcript Edited for Clarity

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