ArchiveApril 2019

Guest post: Part 2 of Choosing a DMT: the issues

Firstly, why the incredible hesitancy among some medics to flip the pyramid? Or at least break away from the Beta-interferons/Glatiramer Acetate as ‘safe’ fallback options, even when the research suggests that these days, the older first generation drugs give suboptimal outcomes compared to the modern crop. The MS neurologists that I spoke to all advocate versions of outlining the options...

Predicting a relapse

The longer I work in MS the more I realize how unpredictable it is. There are complications in diagnosis, in assessing treatment efficacy, in prognosticating, and in achieving homogeneity in clinical practice. The complications are complicated. But what if you have a test done, albeit quite randomly and it tells you something bad is going to happen in the near future – would you ignore it...

Teriflunomide is contraindicated in pregnancy

Abstract BACKGROUND: Teriflunomide is contraindicated in pregnancy. Some pregnancies have occurred despite guidance to use effective contraception. OBJECTIVES:To report outcomes of pregnancies occurring in teriflunomide clinical trials and the post-marketing setting. METHODS: Outcomes are summarized for pregnancies in teriflunomide monotherapy clinical trials and the post-marketing setting (data...

Haemophagocytic lymphohistiocytosis post-alemtuzumab

After yesterday’s post on alemtuzumab-related posts, many people are asking about haemophagocytic lymphohistiocytosis (HLH), which has been included as a complication of alemtuzumab treatment as is now in the SmPC (summary of product characteristics). HLH is a condition in which the body makes too many activated macrophages and lymphocytes. People with HLH usually develop systemic symptoms, which...

There is a reason why Neuros should not be comedians-Don’t change your appointments

Hello Peeps, for regular blog readers you know that I am the funny one, who can light up your day with a smile and a bit of light relief. For people attending ProfGs clinics who don’t want to read this look at the Red The neuros are the serious ones in grey suits who tell you how it is and dole our the good and bad news and sometimes tell you about their inner sensitive self. I woud say I...

Alemtuzumab use put on Restriction

The European Medicines Agency (EMA) has started a review of alemtuzumab following recet reoports of sde effects affecting the heart, blood vessels, liver and immune system.  These side effects are rare but potentially serious. As a temporary measure while the review is being carried out, the EMA has advised that alemtuzumab should only be started in people with relapsing remitting MS that...

Alemtuzumab’s Article 20

Use of multiple sclerosis medicine Lemtrada restricted while EMA review is ongoing EMA has started a review of the multiple sclerosis medicine Lemtrada (alemtuzumab) following new reports of immune-mediated conditions (caused by the body’s defence system not working properly) and problems with the heart and blood vessels with the medicine, including fatal cases. As a temporary measure while the...

A treatment for PML

It seems this is PML week. first PML on alemtuzumab and now this….a treatment for PML or is that that Two I first thought wow….but then I read the title and I thought that maybe I’m being a bit thick here because I have seen a few people wetting their pants on twitter with excitement on this news, but maybe I am missing something? You have a disease that causes white blood cells...

Guest post: Free online course now open!

Along with a great team from the Menzies Institute for Medical Research at the University of Tasmania (Australia) and Multiple Sclerosis Ltd., I have spent the past year building a 6-week online course about MS for the MS community and the general public. The course, entitled “Understanding MS”, has recently opened for enrolments and will begin on Monday 29 April 2019. The course presents up-to...

PML on Alemtuzumab

Immune profiling of a patient with alemtuzumab-associated progressive multifocal leukoencephalopathy. Gerevini S, Capra R, Bertoli D, Sottini A, Imberti L. Mult Scler. 2019 Apr 9:1352458519832259.  A 31-year-old woman affected by multiple sclerosis (MS) experienced generalized tonic-clonic seizures 2 months after the second alemtuzumab cycle. Positive JC virus (JCV)-DNA in cerebrospinal...

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