The Changing Neuroinflammatory Response in Progressive 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 Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2021, 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.

To find out more about the talk, NeurologyLive 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.

For more coverage of ACTRIMS Forum 2021, click here.