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
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!