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Derisking anti-CD20 therapy

An important highlight of ECTRIMS this year was the data on the safety of the anti-CD20 therapies as a class. It is clear that prolonged, and sustained, B-cell depletion is not safe. Hypogammaglobulinaemia will become a problem with the risk of both common and opportunistic infections.  Stephen Hauser presented the 7-year ocrelizumab safety data and there is a clear uptick in infections in...

Extending dosing to reduce PML Risk

I suspect you will get a piece on this from ProfG in a few weeks . As you know natalizumab is a very good drug for stopping disease activity of the brain. However it is also good at stopping immune surveillence of the brain and if you are one of the 50% of people who are infected with the John Cunningham (JC) virus you are at risk from a brain disease called Progressive multifocal...

Help

I have been tasked with designing an International MS Masterclass to teach neurologists and other HCPS (healthcare professionals) about MS. The idea is to run four 2-day courses. I have put together the following draft programme and would appreciate your thoughts on it. If you have MS is there anything that you want to be added, i.e. is there anything that you would want your HCPs to know about...

The Nocebo Effect

Placebo: A dummy medicine containing no active ingredients; Nocebo: A substance which a patient experiences as harmful due to a previous negative perception, but which is in act pharmacologically (medicinally) inactive. Nocebo in multiple sclerosis trials: A meta-analysis on oral and newer injectable disease-modifying treatments. Gklinos P, Papadopoulos D, Mitsikostas DD. Mult Scler Relat Disord...

American Military show that MS starts years before it shows itself

Migration data suggests that people contract the MS trigger before the aga of 15 but we know from clinical studies that it often doesn’t show itself for years later. However it appears that this grumbles on for many years before it rears its ugly head. The American Mitltary is a big beast full of healthy young people who get good medical check-ups. They have their bloods taken and stored...

Genius

My #ECTRIMS2019 highlight #3 is the elevation of fatigue to be the first secondary outcome measure in a clinical trial. Was this genius or a marketing coup? I would have loved to be a fly on the wall when the steering committee of the OPTIMUM study made the decision to bump fatigue to the top of the secondary outcomes. If you have MS you know that the most troubling symptom the majority of MSers...

All for one and one for all

“All for one and one for all”- The Musketeers FACTS Fact 1 – Siponimod (Novartis Pharmaceuticals) trialed for SPMS, but the FDA label sits as Clinically isolated syndrome (the first clinical episode), Relapsing-remitting MS, and active Secondary progressive MS. Fact 2 – Ocrelizumab (Genentech, Roche Pharmaceuticals) trialed for RRMS/PPMS; the latter has been shown to be...

What remains to be achieved?

I had many requests for my #ECTRIMS2019 ‘Hot Topic’ slides on ‘what remains to be achieved from DMTs’. You can download the slides from my SlideShare site. My message is blunt and to the point. Let’s not let ourselves be lulled into a false sense of security with our current crop of DMTs. They are simply not good enough. If we want to ‘maximise the lifelong...

Prof K

Whilst we were at ECTRIMS in Stockholm DrK got an email from our University informing him that his promotion was successful! Dr K is now Prof K! I think we should all clap hands, raise a glass of champagne and congratulate him on a well-deserved promotion.  Professor Klaus Schmierer ProfK’s academic accomplishments have been well-rehearsed on this blog. He is an international expert on...

Real Life

After my #1 highlight #ECTRIMS2019 post, I was sent an email by Antoinio Scalafari, a like-minded colleague, to remind me of their real-life data at Imperial College on alemtuzumab in clinical practice. It mirrors the trial experience and needs a platform for discussion (see below). In parallel, I heard via the MS grapevine that the MS community does not appreciate me questioning the ethics of...

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