Migration data suggests that people contract the MS trigger before the aga of 15 but we know from clinical studies that it often doesn’t show itself for years later. However it appears that this grumbles on for many years before it rears its ugly head. The American Mitltary is a big beast full of healthy young people who get good medical check-ups. They have their bloods taken and stored...
Genius
My #ECTRIMS2019 highlight #3 is the elevation of fatigue to be the first secondary outcome measure in a clinical trial. Was this genius or a marketing coup? I would have loved to be a fly on the wall when the steering committee of the OPTIMUM study made the decision to bump fatigue to the top of the secondary outcomes. If you have MS you know that the most troubling symptom the majority of MSers...
All for one and one for all
“All for one and one for all”- The Musketeers FACTS Fact 1 – Siponimod (Novartis Pharmaceuticals) trialed for SPMS, but the FDA label sits as Clinically isolated syndrome (the first clinical episode), Relapsing-remitting MS, and active Secondary progressive MS. Fact 2 – Ocrelizumab (Genentech, Roche Pharmaceuticals) trialed for RRMS/PPMS; the latter has been shown to be...
What remains to be achieved?
I had many requests for my #ECTRIMS2019 ‘Hot Topic’ slides on ‘what remains to be achieved from DMTs’. You can download the slides from my SlideShare site. My message is blunt and to the point. Let’s not let ourselves be lulled into a false sense of security with our current crop of DMTs. They are simply not good enough. If we want to ‘maximise the lifelong...
Prof K
Whilst we were at ECTRIMS in Stockholm DrK got an email from our University informing him that his promotion was successful! Dr K is now Prof K! I think we should all clap hands, raise a glass of champagne and congratulate him on a well-deserved promotion. Professor Klaus Schmierer ProfK’s academic accomplishments have been well-rehearsed on this blog. He is an international expert on...
Real Life
After my #1 highlight #ECTRIMS2019 post, I was sent an email by Antoinio Scalafari, a like-minded colleague, to remind me of their real-life data at Imperial College on alemtuzumab in clinical practice. It mirrors the trial experience and needs a platform for discussion (see below). In parallel, I heard via the MS grapevine that the MS community does not appreciate me questioning the ethics of...
Black Swan
Most of you know by now that I am one of the main proponents supporting EBV as the primary cause of MS. I think EBV is actively driving MS disease activity. The corollary to this statement is that we may be able to treat MS with anti-EBV drugs. We have suggested that all MS DMTs work by affecting memory B-cell biology and that this is the cell that host the EB virus. At Barts-MS, we have an...
Trials going classical
One of the next new kids on the block is going to be Ofatumumab (Anti-CD20). There were positive data on the MRI scans and on relapse rate that puts it in the league of the big hitters. This is hardly surprsing as it is a Me-Too drug and does the same as rituximab and ocrelizumab. This data was shown at Ectrims2019 in the ASSCLEPIOS (Greek god of healing) trials. OPERA was the trial name for...
Open letter to the EMA
Just back from ECTRIMS 2019 in Stockholm. My highlight was the alemtuzumab 8-year longterm extension data; the brain volume data is quite extraordinary (figure 5). In short, apart from HSCT, there is nothing that comes close to alemtuzumab in radically slowing-down or preventing end-organ damage. Comi et al. Alemtuzumab improves clinical and MRI disease activity outcomes, including slowing of...
Hot Topic the Video Battle of the B cells
The anti CD20 debate You asked about the slides of ProfB and said you don’t get the nuiance of them. Well in this case, we can help. There were 3 sessions that were live streamed, MD2 was watching. I haven’t seen it yet but will be cringey no doubt, but ProfB had a 15minute slot and got through the slides in about 11-12 minutes. So have a watch and see if you thoughts match what was...