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

“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 NeurologyLive 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.