How easy is it to design an algorithm to sequence DMTs?

Last week DrK and I joined an esteemed panel of academic neurologists (all male, unfortunately*) to discuss issues around the sequencing of DMTs.

*We need more women on platforms such this and other MS-related committees. The gender divide is very large in the field of MS. It is very embarrassing to me as a father and husband; my daughters and my wife are card-carrying feminists and every bit as capable as their male peers.  

The following is my presentation that many of you requested. You can download it from SlideShare.

Sequencing of DMTs is a very hot topic and increasingly relevant to how we select DMTs today. What factors do we need to consider when choosing DMTs to make sure it is safe to transition patients onto in the future? 

When making a choice of DMT have you asked your neurologist what drug x does do your future DMT choices? This is something that is becoming increasingly important when selecting DMTs. 

Please stop to think and to ask questions. 

Getting it right the first time is more important than you realise. 


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.


  • I agree that the lack of women involved in MS related research is problematic. This is also problematic within the diagnostic process as I often wonder, after 8 years of trying to confirm a diagnosis, how many women are living with this disease and wasting valuable time as they have difficulty being taken seriously by medical professionals. I must say I find your blog fascinating and contains very useful information. Thank you for your efforts

  • Thankyou for this informative post. Would there be any real advantages to choosing Alemtuzumab rather than Cladribine (apart from being the most effective at reducing brain atrophy) as the latter appears to have much fewer serious side effects?

    • The cladribine brain atrophy data is only up to 2-years, which because of therapeutic lag is probably too soon to make a call on it. It may get better with time.

      I agree with MouseDoctor we need a head-2-head between cladribine and alemtuzumab. When you look at NEDA rates they are pretty similar with the caveat that the population of MSers in the CLARITY study were less active than those in the CARE-MS studies.

      Interestingly, the Germans refer to cladribine as being Alemtuzumab-Light. I prefer referring to as a small molecule anti-CD19 with the added advantage that it may be CNS penetrant.

  • I am surprised that this is even discussed / alemtuzumab should be off the market and allowed only in specaill cases in my humble opinion.
    In the hands of neurologists who do not have much internal medicine experience alemtuzumab is a nuclear bomb. I have Graves disease after this wonderful treatment (a horrible autoimmune disease number 2, after MS) and now it looks like I also have haemolytic anaemia (a nasty autoimmune disease number 3). Both complications where ignored by neurologists despite the monthy blood test monitoring. (Graves is with blocking autoantibodies, so somewhat unusual, but still…).

By Prof G



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