ArchiveMarch 2018

The Phoenix has risen: the era of disease modification in progressive MS has truly arrived

The EXPAND study is the first positive study in people with secondary progressive MS and marks a new landmark in the treatment of MS. Please note that I am a co-author on this paper and I sit on the trial steering committee. I am clearly conflicted and therefore you may not want to read or hear what I have to say about the trial’s findings.  Siponimod is the second-in-class of the so...

If we #Thinkhand we would have another treatment for Progressive MS.

Another DMT for progressive MS bites the dust! Yet another poorly designed progressive trial. If only it had been designed better it would have transformed the management of SPMS. Have we learnt from our mistakes? Kapoor R, Ho PR, Campbell N, Chang I, Deykin A, Forrestal F, Lucas N, Yu B, Arnold DL, Freedman MS, Goldman MD, Hartung HP, Havrdová EK, Jeffery D, Miller A, Sellebjerg F, Cadavid...

Fingolimod inducing low white blood cell levels but saving brain

What are the consequences of having a low lymphocyte count when starting fingolimod? Ohtani R, Mori M, Uchida T, Uzawa A, Masuda H, Liu J, Kuwabara S. Risk factors for fingolimod-induced lymphopenia in multiple sclerosis.Mult Scler J Exp Transl Clin. 2018 Feb 20;4(1):2055217318759692.  BACKGROUND:Lymphopenia is a well-known adverse event of fingolimod, a disease-modifying drug for...

Is it not time to extend the diagnosis of MS into the asymptomatic phase?

At a continuing medical education (CME) meeting I co-chaired in Vienna, a concept emerged that is silently gnawing away at my consciousness and has changed my thinking. The concept concerns how we deal with the problem of the radiologically isolated syndrome (RIS) or asymptomatic MS. I have openly criticised the New McDonald criteria for not allowing us to make a diagnosis of asymptomatic MS. Why...

Adult brain size is affected more by childhood onset MS

Paediatric-onset MS comes at a price; a smaller brain in adulthood. Mult Scler Relat Disord. 2018 Mar 6;21:103-107. doi: 10.1016/j.msard.2018.03.004. [Epub ahead of print] Adult brain volume in multiple sclerosis: The impact of paediatric onset. Fenu G, Lorefice L, Loi L, Sechi V, Contu F, Coghe G, Frau J, Spinicci G, Barracciu MA, Marrosu MG, Cocco E. Abstract BACKGROUND: Paediatric onset...

Cladribine selectively depletes B cells and induces long term depletion of memory B cells

Last year we suggested that all agents that currently are used to inhibit MS, all target memory B cells. The agents that are highly-effective deplete memory B cells well and those that are not highly-effective don’t. We didn’t have the data on whether cladribine depletes memory B cells, but as cladribine is highly effective in treating relapsing MS. It suggests that they should be...

MS in the News HSCT poster doing the rounds

“Game changing” HSCT data is being reported in the media. This is in response to data being presented at a meeting, which we commented on a few weeks ago.. I saw Roumen Balabanov last week and he wasn’t aware that the abstract below was published. We made a post where the authors had complained about Social media as inaccurate, but I made the point that the authors are happy to...

#Thinkhand – Natalizumab preserves upper limb function in advanced disease

Most people with MS will have discrete episodes of disability – relapses – from which they get better. Unfortunately over time, many people gradually accumulate disability and stop having clear relapses. This shift is often labelled as a shift from ‘relapsing’ to ‘progressive’ disease, and once in the second phase people are often given the label...

Charcot 3: does an anti-viral inhibit MS?

Does an anti-viral inhibit MS? Charcot 1 is still not published (nudge, nudge) but it didn’t work but that didn’t surprise me as the treatment agent prevented virus integrating into the DNA, which was targeting a virus that had already integrated. However there was anecdote of disease remission after taking the drug. It has happened again: Drosu NC, Edelman ER, Housman DE. Could...

Guest Authors: The alternative view

Earlier this week a piece was published in the Annals of Neurology reporting how certain authors are on clinical trials and implying that they could be “guest authors”; celebrated “key opinion leaders” who do not contribute to trial design or execution, or manuscript drafting, but whose name lends gravitas to the study. Today Prof A gives a response to this. First I must say that Prof...

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