Induction Versus Escalation to Treat MS: Barry Hendin, MD

"We’ve reached a time where we can move to higher-efficacy agents without incurring additional immunosuppressive hazard. I can move up from less agents to better agents without significant increase in risk, and all of those things compel me toward the earlier use of high-efficacy agents.”

Not all patients presenting with their first attack of multiple sclerosis (MS) or early thereafter are necessarily in the same phase of the disease. Some present with minimal signs of disease and/or symptoms, whereas others present late, having accumulated already considerable damage to the central nervous system. Since the advent of disease-modifying therapies (DMTs), clinicians have debated whether an induction or escalation approach is best suited for this patient population.

Using an induction approach entails applying the higher-efficacy agents early while escalation gradually brings the patient up to the most efficacious therapies over time. In recent years, clinicians have trended towards induction, but some clinicians are adamant that each patient’s regimen should be tailored to them, and that grouping all patients to one approach is inconsiderate.

Barry Hendin, MD, neurologist, Banner Health, and chief medical officer, MS Association of America, sees both sides of the argument. In an interview with NeurologyLive, he noted that there’s a greater tendency to start higher efficacy agents early in academy centers while the community perspective favors initiating treatment with simpler agents. He provided his thoughts on where he stands, and why the age-old debate will continue on until there is more scientific data to back each approach up.