Treat early and effectively

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You may think I am a stuck record , Yes I am. But I need to keep crapping -on because some people just aren’t listening!.

I am so, so saddened that some of my so called colleagues…well ProfG’s colleagues are unable to assimilate knowledge and are quite happy to do nothing….but watch as people in their care deteriorate.

How much evidence do we need to say that getting on top of MS quickly and effectively is a good thing….To think otherwise is to not Think!

Relapse numbers and earlier intervention by disease modifying drugs are related with progression of less brain atrophy in patients with multiple sclerosis.Masuda H, Mori M, Hirano S, Kojima K, Uzawa A, Uchida T, Ohtani R, Kuwabara S.J Neurol Sci. 2019 Jun 10;403:78-84. 

Long term effect between disease-modifying drugs (DMDs) treatment duration and brain atrophy rate has not been fully investigated in patients with relapsing-remitting MS (RRMS). The aim of this study was to investigate whether DMDs could slow down the progression of brain atrophy in patients with RRMS by comparing DMDs-treated group with non-treated group during a certain period of time. This was a retrospective investigation. Forty-nine RRMS patients underwent two brain MRI scans more than one year apart. Between scans, patients were treated with fingolimod (n = 16), interferon-beta (n = 23) or not treated with DMD (n = 10). Correlations between clinical characteristics and brain volume were calculated by statistical parametric mapping-12. In all 49 patients, the total attack number before 1st MRI scan and the annualized rate of total lesion volume change between the two scans showed a positive correlation with annualized atrophy rate of grey matter volume (GMV) plus white matter volume (WMV). In patients with DMDs (n = 39), the period from drug initiation to 1st MRI scan was negatively correlated with the annualized atrophy rate of GMV + WMV and number of attacks between scans. The number of t

And Another

Long-term disease activity and disability progression in relapsing-remitting multiple sclerosis patients on natalizumab. Dekker I, Leurs CE, Hagens MHJ, van Kempen ZLE, Kleerekooper I, Lissenberg-Witte BI, Barkhof F, Uitdehaag BMJ, Balk LJ, Wattjes MP, Killestein J. Mult Scler Relat Disord. 2019 May 28;33:82-87. doi: 10.1016/j.msard.2019.05.017. [Epub ahead of print] BACKGROUND:Natalizumab is an effective treatment for relapsing-remitting multiple sclerosis (RRMS). Data on clinical and imaging measures predictive of disease activity and progression during treatment is limited OBJECTIVE:To determine clinical and imaging predictors of long-term inflammatory disease activity and disability progression in RRMS patients on natalizumab.METHODS:Patients (n = 135) were selected from our prospective observational natalizumab cohort and monitored using brain MRI and extensive clinical testing. Progression and improvement on the Expanded Disability Status Scale (EDSS), no evidence of disease activity (NEDA) and no evidence of progression or active disease (NEPAD) status were determined using measurements after the initial phase of inflammation and the early anti-inflammatory impact of natalizumab.RESULTS: EDSS progression was seen in 43.7% of patients and EDSS improvement in 17.8%. Median follow-up was 4.9 years (IQR 3.6-6.0). Patients with a longer disease duration at natalizumab initiation have a higher hazard for earlier EDSS progression (HR 1.05, CI 1.00-1.09, p = 0.037) and a higher pre-baseline relapse rate predicted a longer NEPAD status (HR 1.70, CI 1.06-2.72, p = 0.028).CONCLUSION:The results suggest that starting natalizumab early, during active inflammatory disease results in a more favourable outcome. When taking into account early inflammation and the impact of natalizumab on disease activity during the initial treatment phase, a higher than expected proportion of patients showed disability progression.

Will DrK/ProfG ever convince the powers that be to do the ATTACK trial? or is that the NATTACK (DrK and ProfG are madmen!) trial? Putting people on natalizumab to stop MS causing more damage whilst you do the diagnostic work up.

Am I insulting the bosses calling them madmen? ProfG has been called the “Don” by DrDrey after all.

No, I don’t mean madmen as in loonies…but as people who could have been on Maddison Avenue in an advertising agency coming up ideas on branding ProfG the Don Draper of the MS slogan world:-).

However, some neurologists still live under a rock 🙂 and won’t go near effective disease modifying drugs:-(….They should carry a health warning!

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MouseDoctor

6 comments

  • Can we set up a website where the dinosaur neurologists are listed? I think this is the only way of helping patients. No point trying to change the dinosaurs so let’s just make those neuros who live under rocks known.

    • ILd.love to do it but would be taken to task by the bosses. as the neuros are not going to do this ….profG and DrK get enough grief and doing such a thing would not be a good career move as tryanosaurus rex is a top dinosaur……Maybe someone could do a freedom of information request of what drugs are prescribed in the MS centres. I bet the dinosaurs prescribe nothing or little else than CRAB drugs and don’t go near Alemtuzumab in case they s**t themselves with fear that it may do something useful.
      Sadly I fear that you will need a sea of retirements to clear out the old guard who did their training in the era of watch and wait and do nothing..

  • And then what NAZ is not a cure…
    and alot don’t respond to Alemtuzamab.

    How do you avoid smoldering your brain for 25 years..?

  • Not just the neuro but how thety influence their team.

    Many of the newly diagnosed are struggling with the news and then – as related to me by a young woman in Liverpool – just the other day the nurse is alleged to have told her that the new DMTs are still unproven, a bit dangerous and most people go for Glatiramer Acetate. The Messenger Credibility factor, the Ordering Effect and so on. Now said patient has read on here, read on other forums, and is feeling quite discombobulated. They want to trust and believe in their team but no longer do. Furthermore, a young person who has never really had to engage with the NHS, has a default trust in Doctors is now being faced with uncomfortable choices and a complete lack of clinical support to deviate from Nurse Knows Best.

    I wonder where said nurse got that line from? Not their glorious leader? Surely not.

    • Yeah, that’s really concerning. My experience has been vastly different. My wife is half way through her first course of alemtuzumab. First line treatment. MS nurse and neurologist both believe in high efficacy treatments early. There are risks though. Day 3 and possible pulmonary embolism. Typing this whilst waiting for CT. With that said, we don’t have any regrets.

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