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NEDADI or ‘Nee Daddy’ another treatment target beyond NEDA

Prof G do you think disability improvement is a reasonable treatment goal? NEDADI = no evident disease activity and disability improvement Two weeks ago one of my patients with PPMS, who we treated with off-label subcutaneous cladribine, came for her annual follow-up appointment. Despite being treated with cladribine over 2 years ago she has unfortunately progressed from EDSS 5.5 to 6.5. Her...

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How does cladribine work?

As promised, I now provide you with a link that will provide you with full and free access to the paper for fifty days. You can download, read and come back to ask questions. Here is the link.

Enjoy.
COI Multiple This was not company sponsored

Playing second fiddle to the Swedes

Why can’t we use anti-CD20 therapies as immune constitution therapies? For some years we have been promoting our Barts-MS Essential DMT list to treat people with MS (pwMS) in resource-poor environments. One of the big guns on our list has been rituximab (anti-CD20).  One of the problems is that rituximab at a dose of 1g every 6 months is still too expensive to accessible for the vast...

Spanner in the works for intrathecal rituximab

Figure: To-and-fro bi-directionality of CSF flow in the brainBy © Nevit Dilmen, CC BY-SA 3.0 I get a sinking feeling in the pit of my stomach when I read this article. Starting out in science, one is considered smart when following the trends of the populist. As a seasoned scientist, when one continues to work in this way, one is just not being too clever. I am not being disparaging of those who...

Are nutritional supplements a waste of money?

Do you take dietary supplements? If yes, are you prepared to review what you are taking and ask yourself if you need to spend the money taking something that is not supported by any evidence? In the US the Food and Drug Administration (FDA) has recently announced measures to regulate dietary supplements. The FDA Commissioner Scott Gottlieb said: “It’s clear that the US Food and Drug...

Skint Britain

Did anyone watch ‘Skint Britain: friends without benefits’ on Channel 4 in the week? ‘Skint Britain: friends without benefits’ looks at the rollout and impact of the new Universal Credit scheme for British people who are unemployed or unable to work. The ‘big idea’ behind universal credit is to incentivise people who are unemployed to work or at least to be shown to be actively seeking work in...

EDSS

Time between expanded disability status scale (EDSS) scores.Zurawski J, Glanz BI, Chua A, Lokhande H, Rotstein D, Weiner H, Engler D, Chitnis T, Healy BC. Mult Scler Relat Disord. 2019 Feb 5;30:98-103.  BACKGROUND: Although the expanded disability status scale (EDSS) is the most commonly used measure of disability for multiple sclerosis, measurement of disability accumulation is complex...

More B cell stuff. Don’t deal with the B cells…Don’t deal with disease?

Longitudinally persistent cerebrospinal fluid B-cells can resist treatment in multiple sclerosis.Greenfield AL, Dandekar R, Ramesh A, Eggers EL, Wu H, Laurent S, Harkin W, Pierson NS, Weber MS, Henry RG, Bischof A, Cree BA, Hauser SL, Wilson MR, von Büdingen HC. JCI Insight. 2019 Feb 12. pii: 126599. doi: 10.1172/jci.insight.126599. [Epub ahead of print] B-cells are key contributors to...

What to do about my haloes?

Why do MS lesions with an iron halo continue to expand? The slowly expanding MS lesion or SEL is where the money or lack of money is. In my post ‘explaining why you are getting worse despite being NEDA‘ I mention SELs as one of the reasons that underlie progressive MS and are largely unresponsive or poorly responsive, to standard DMTs. Danny Reich’s team at the NIH have...

To B or Not to B..that’s is ProfG’s Atrophy Question

Effect of disease-modifying therapies on subcortical gray matter atrophy in multiple sclerosis.Sotirchos ES, Gonzalez-Caldito N, Dewey BE, Fitzgerald KC, Glaister J, Filippatou A, Ogbuokiri E, Feldman S, Kwakyi O, Risher H, Crainiceanu C, Pham DL, Van Zijl PC, Mowry EM, Reich DS, Prince JL, Calabresi PA, Saidha S. Mult Scler. 2019 Feb 11:1352458519826364. BACKGROUND:The effects of disease...

How Does Cladribine Work?

Here is a new offering from the CLAD lads :-), and follows on from the information that we got from the European Medicines Agency and from stuff in the public domain. This is not a pharma supported piece of work and they may have different views of how cladribine works or how they want to portray how they think this works, but as usual for us, it contains ideas of the unknown. Things we and...

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