Multiple sclerosis expert shares insights into research, innovations, and hope for the future.
Neurologist Dr. Barry Singer sits down with Accredo’s Diana Florio to discuss his life-long pursuit to help patients live well with MS.
I recently met with Barry Singer, M.D., a world-renowned neurologist specializing in multiple sclerosis (MS) at The MS Center for Innovations in Care in the Missouri Baptist Medical Center in St. Louis, as he was preparing to hop a flight to Germany to present on advancing MS care at a university hospital. Our time together was only a brief snapshot of a day-in-the-life of Dr. Singer, as his distinguished career spans over two decades. His contributions to the field are invaluable; all of which underscore his commitment to patient care, advocacy, and innovative research.
Dr. Singer, what inspired you to specialize in neurology, specifically in MS?
My journey into the neurology field was influenced by an experience I had as a child, my grandmother's battle with Parkinson’s disease. This deeply affected me and sparked an interest in the human nervous system which carried through into my academic pursuits.
I graduated from Duke University and Columbia University for undergraduate and medical degrees, respectively. After which I completed a neurology residency at Cornell-New York Hospital and a two-year MS fellowship at the National Institutes of Health (NIH).
My interest in immunology and interaction with MS patients during medical school further fueled my passion for the field. Witnessing the disease's impact particularly on young patients and the limited treatment options available at the time motivated me to specialize in MS.
There are so many exciting advancements in MS treatment. What excites you the most about the future of MS therapies?
I am particularly excited about the use of high-efficacy treatments early in the disease course and advancements in targeting progressive forms of MS. Monoclonal antibody treatments have dramatic ability to control inflammatory disease activity including both relapses and new MRI disease activity
Over the past seven years, three B-cell monoclonal antibody treatments have been approved. Compared to older drugs which prevented about 80% of active brain lesions seen on MRI imaging with contrast, these antibody medications are up to 97% more effective. For progressive MS, we have studied a class of medications called BTK inhibitors that affect cells within the brain and spinal cord.
New exciting research has been focused on Epstein-Barr virus which plays a role in triggering MS and potentially propagating MS disease activity.
Your philosophy is patient-centered, meaning a patient and their physician should work together as partners to form a comprehensive treatment plan. What do you recommend to physicians treating MS patients?
Emphasizing the need for a collaborative partnership between physician and patient cannot be overstated. The goal for my patients, and all MS patients, is to live well with their condition. And that means something different for each person.
There are over 20 FDA-approved treatments for MS, so the decision-making process for appropriate treatment for each individual has become increasing complex. It is critical for a patient-physician relationship to be collaborative when selecting the right medication. You need to understand the patient’s goals and concerns because you want to select a medication that the patient is comfortable with adhering to. After learning about a patient’s preferences and needs, I narrow the list down to two or three and we work together to decide which therapy will be the best for them.
It is important to set up long-term treatment goals with your patients, considering factors such as disease activity (amount of brain/spinal cord lesions and relapse frequency)), route of administration, individual risk factors, side effects and importantly, patient preferences. This approach will help ensure the treatment plan is tailored to meet the unique needs of your patient, with a focus on wellness, preventing disability and enhancing their overall quality of life.
As for your point about the number of available medications, there are more than ever before and understanding the distinctions of each can be daunting. Tell me more about your mission to educate your peers and patients across the world on their options.
There are nuances to each therapy and as a physician it is imperative to understand the complexities of each. Many MS patients have other medical problems (comorbidities). For example, if you have poorly controlled diabetes, there’s an increased risk of swelling in the back of eye on one class of medications. Some medications can cause an increase in blood pressure, high liver blood tests and risk of serious infections. If you have another autoimmune disease such as rheumatoid arthritis or psoriasis, coordination of care of immunotherapies is important.
All this to say, that the education of my peers and patients is something I have been passionate about since the beginning. I started MS Living Well, a patient education website, in 2008 and it has reached over 600,000 individuals all over the world. Global experts have joined me as host of the MS Living Well podcast for the past 6 years. My goal is for patients to find a community and gather information that is relevant to their condition, so they can discuss with their health care professional and continue the conversation.
MS patients are often challenged with their physical symptoms and mental health. How do you recommend supporting patients while continuously striving to optimize their health status?
Symptoms that MS patients face are often debilitating and significantly affect ADLs (activities of daily living) and diminish overall quality of life. About 90% of patients report fatigue. Bladder issues, nerve pain and cognitive impairment are some of the other most common symptoms experienced by patients.
A multidisciplinary approach is my recommendation. Incorporating non-pharmacological strategies such as exercise can reduce fatigue. Medications and therapy are often initiated to help address depression and anxiety, which are very common in people living with MS. Treatment is especially important since poor mental health worsens MS symptoms and depression has been associated with high risk of worsening disability.
Even when using a patient-centered comprehensive approach, therapy adherence can be a concern. How can physicians address barriers to ensure a patient adheres to their therapy regimen?
When it comes to ensuring patients adhere to their prescribed therapy, it all starts with open communication. I make it a point to engage in meaningful conversations with each of my patients and show patients their MRI scan images. Whether it is discussing treatment goals or addressing concerns, I involve patients and their support networks, be it family or friends, to ensure everyone understands the rationale behind the prescribed therapy.
Sometimes I see patients that had an attack and recovered; they are young and do not have any symptoms, so they wonder if continuing therapy is the right decision. Explaining goals of treatment with patient is key; treating a chronic disease effectively early and long term leads to better quality of life with aging. If a specific medication is causing poorly tolerated side effects or dosing schedule problematic for the patient, neurologists should consider an alternative treatment for MS patients.
A specialty pharmacy can also support a physician to help remove obstacles by following up with patients if they are not refilling their medications on time. This helps the physician understand issues a patient may be facing – if it is a financial issue or benefits determination.
Finally, what else do you want to share with our readers?
I will end speaking to directly to people living with MS: the most important thing to remember is that we have highly effective therapies available now. There are some patients that have not circled back with their physician in a long time. If someone with MS is not on treatment, I encourage revisiting a neurologist to explore new options. Many people tried the original first line of medications which were self-injected, and many patients did not tolerate it well.
Taking a therapy regularly makes a dramatic difference in controlling the disease long-term. Just like diabetes and hypertension, if you have a chronic disease, you need to treat it to control it. The goal is to live well with MS.
