Unrelated Blogger Comments – April 2013

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Sometimes you want to say something that is unrelated to the threads. This is a spot for You. Previous comments can be got at on the posts on the right of the main page.

April Showers

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

26 comments

  • Just wanted to say I visited the Walton Centre today and the neurologists were full of admiration of this blog and of Prof G for being courageous enough to do it. You guys are doing an amazing job. All eyes are on this site. Dare I say it, what you're doing is truly historic. Always have faith in what you do because we all do: All of us!

  • I dont know of any other blog where doctors answer questions/comments without charging a fee. Thanks. Recently, Nature Neuroscience published an article on ALS and the role of oligodendrocytes in the pathology. Loss of myelin and trophic effect contribute to motor neuron loss. There seems to be more similarities in the neurodegenerative disease spectrum than previously thought.

    • Yes, one of the drugs about to be tested in MS is an ALS drug. Nerves get damaged in both diseases and whilst the triggers may be different there are no doubt similarities as you say.

  • Hi, I was having trouble to find any update new from Novatris on Gilenya/PPMS trial and Geneuro/MSRV antibody on AAN. Did Prof G attended any of mentioned sessions? Do you remember some numbers?

    • The Novartis fingolimod PPMS study is fully recruited; we should get results late 2014. Data was presented on the safety of the Geneuro/MSRV antibody; the company has plans to do a phase 2a study in MSers. Nothing new to report outside the drug did not cause any problems in health control subjects.

  • Maybe we have just seen the light?

    United States Patent Application Publication
    US 2013/0096158 A1
    Apr. 18, 2013

    TREATMENT OF MULTIPLE SCLEROSIS WITH COMBINATION OF LAQUINIMOD AND FINGOLIMOD

    Very interesting patent application published yesterday. Check page 2. Disease activity stops 100% with low dosage Gilenya/LAQ-combo

    " [0204] However, while the lower dosages tested (10 mg/kg
    laquinimod and 0.3 mg/kg fingolimod) were moderately
    effective individually, the combination of fingolimod and
    laquinimod when each was administered at its respective
    lower dosage was so potent that it completely abrogated disease.
    This unexpected result suggest that lower and suboptimal
    dosages of laquinimod and fingolimod can be used in
    combination to achieve a greater than additive therapeutic
    result, and provides evidence that such a combination can be
    used for therapeutic treatment of human MS and CIS patients. "

    Your thoughs on this?

    • This is a patent from TEVA

      As a DMT on its own the results with laquinimod were disappointing. However the interesting result was that it appeared to do more on atrophy than its effect on relapsing disease would suggest. Would this be a useful neuroprotective.

      In animals both laquinimod and fingolimod can inhibit immune disease, this patent suggests that if you use suboptimal doses they have combinational value so two drugs can be better than one. However if you put fingolimod up to its active dose, this will inhibit EAE completely. What extra benefit would be get then, increased risk of side effect.

      Would Novartis make a smaller pill so Teva can get laquinimod another go. I suspect a lower dose Gilenya pill will also still be active.
      There is only one way to know if two drugs are better than one, do a trial and find out. This will be down to TEVA.

      There are other patents doing just the same,eg Larry Steinman has one with ACE (Angiotensin converting enzymne) inhibitors, so the concept is not new.

  • Since Fingolimod data exclusivity seems to expire in the US in 2015, and the basic patent protection for Fingolimod have priority from Sep 1997 ( if I don't miss something ) I guess TEVA will get a very interesting possibility to make generic Gilenya and combine with LAQ.

    Most likely Fingolimod is one of the 2-3 "other drugs" ( beside Copaxone ) TEVA will initiate registration studies for during 2013.

  • Some details can be read on this web-site

    http://www.drugs.com/availability/generic-gilenya.html

    "
    Related Exclusivities

    Exclusivity is exclusive marketing rights granted by the FDA upon approval of a drug and can run concurrently with a patent or not. Exclusivity is a statutory provision and is granted to an NDA applicant if statutory requirements are met.

    Exclusivity expiration dates:
    July 20, 2014 – ADDITION OF THE T1-WEIGHTED GD-ENHANCED LESION EFFICACY VARIABLE IN THE CLINICAL STUDIES SECTION 14 OF THE PACKAGE INSERT
    September 21, 2015 – NEW CHEMICAL ENTITY
    "

  • Just watched the Mitchell & Webb clip, very very funny. I thought the irony of your motto 'An Holistic Approach to MS form Gavin Giovannoni made me laugh that little bit more 🙂

    We are all looking for class 1 evidence and that includes pharma drugs, omega3 , thinking yourself better and indeed Vit D etc etc.

    http://www.medicalnewstoday.com/releases/259414.php

    Regards as always, btw still chuckling, ( fine find)

  • Is MS the cause of the immunology in the gut or is the immunology in the gut the cause of MS?

    Animation: Immunology in the Gut Mucosa

    The gut mucosa is the largest and most dynamic immunological environment of the body. It's often the first point of pathogen exposure and many microbes use it as a beachhead into the rest of the body. The gut immune system therefore needs to be ready to respond to pathogens but at the same time it is constantly exposed to innocuous environmental antigens, food particles and commensal microflora which need to be tolerated. Misdirected immune responses to harmless antigens are the underlying cause of food allergies and debilitating conditions such as inflammatory bowel disease. This animation introduces the key cells and molecular players involved in gut immunohomeostasis and disease.

    http://www.nature.com/ni/multimedia/mucosal/animation/index.html

    • There is at of interest in the effect of microbdes on influencing the immune response. This is the microbiome.. there are many people collecting pooh to check this out….not that is a s**t job :-).

      Intersting video if your interest is inflammatory bowel disease if your interest is MS em. Howver the players in IB disease are the same as in MS and NMO (neutophils)

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