Q&A April 2020

Q

Q & A. If you have questions related to COVID-19 please go to the Microsite that Prof G has set up…you will get your answers there (See above).

Flowers and an AngryMask. Feb 14 comes late to Our House Hold…She gave me the Virus, bet it was just a Rhinovirus (Cold)

Questions for MS…Here

About the author

MouseDoctor

96 comments

  • Given that coronaviruses can affect the brain, can be neurotropic, neuroinvasive, is there any research into coronaviruses as triggers of MS?

    I’m very curious, because Rhinoviruses are a trigger for permanent worsening of my otherwise very stable PPMS.

  • Is all MS research (across the world) effectively on hold until the lockdown loosens? What about all the presentations, trial results and posters that were due to be given / announced at the AAN conference in April?

    I hope all researchers (across all diseases) are using the time at home to write up papers etc. which were on the to-do list.

    • I believe so…only covid projects are allowed to occur and even this is vetted…The AAN has been postponed but they have still got a program ONline

      1-007 – Alemtuzumab Depletion Failure and Neutralizing Anti-Drug Antibodies: a Case Report and Call for Monitoring
      Kathleen Munger, MD

      Background
      Alemtuzumab is a monoclonal antibody that targets CD52 positive T-cells and B-cells, and is used to treat relapsing remitting multiple sclerosis. However, despite humanization and depletion of peripheral T and B cells, alemtuzumab generates the highest frequency of binding and neutralizing antibodies of all humanized antibodies currently in clinical use. In some individuals, antibody neutralization appears to be sufficiently severe to allow disease-breakthrough.

      Objective
      The objective of this report is to highlight a need to re-evaluate how we approach and monitor anti-drug antibodies to alemtuzumab during treatment of patients with multiple sclerosis.

      Design Methods
      Case report

      Results
      A 40 year old woman with MS was started on alemtuzumab in June 2015. She had breakthrough disease activity in September 2018, so received her third cycle of alemtuzumab in December 2018. In July 2019 she developed right eye blurry vision and bilateral lower extremity weakness. MRIs demonstrated longitudinally extensive right optic neuritis, 17 enhancing lesions throughout the cerebral hemispheres, corpus callosum, and brainstem, five enhancing cervical cord lesions, and two enhancing thoracic cord lesions. Review of her records revealed that her lymphocytes did not deplete following the third cycle of alemtuzumab. A novel serum assay was performed which demonstrated a very high titer of binding and neutralizing alemtuzumab anti-drug antibodies (>7.7 x 105 Lux) compared to an untreated serum sample (1.22 x 104 Lux).

      Conclusions
      We conclude that the new lesions were secondary to multiple sclerosis, unchecked as a result of alemtuzumab lymphocyte depletion failure. We are concerned that depletion failure was secondary to the presence of alemtuzumab neutralizing antibodies. We propose that following lymphocyte counts in the months after treatment should be routine, if not imperative, with the goal of monitoring for the risk of treatment failure. More pro-actively, evaluating for neutralizing antibodies before administering third or fourth cycles of treatment should be explored further.

      Actually something extra do do maybe we can have a virtual AAN

      -006 – Revealing the Immune Cell Subtype Reconstitution Profile in Cladribine Treated Patients at the 96 Week Timepoint (CLARITY) Using Deconvolution Algorithms Irinia Kalatskaya

      Background
      Cladribine tablets (CT) cumulative licensed dose of 3.5mg/kg (CT3.5), administered as two short oral courses over 2 years, transiently reduces total lymphocyte counts, with median values returning to normal range within 11 months and median B-cells by 6 months. Clinical efficacy of CT is sustained beyond lymphocyte recovery. Flow cytometric observations suggest long-lasting reductions in memory B-cells.

      Objective: Characterize immune cell transcriptomic signatures in peripheral blood from patients with relapsing-remitting multiple sclerosis during immune repopulation at 96 weeks in the CLARITY study using advanced computational algorithms and to correlate these signatures with corresponding flow cytometry data of main lymphocyte subtypes.

      Design Methods:Gene expression data (U133 Plus 2.0 array) in whole blood samples at 96 weeks were available from patients randomized to placebo (n=57), CT3.5 (n=62) or CT 5.25mg/kg (CT5.25, n=70). These were analyzed with the CIBERSORT deconvolution algorithm (to estimate absolute fractions of 22 immune cell subtypes) and the xCell signature-based method (cell type enrichment analysis for 43 immune cell subtypes). Wilcoxon Rank Sum tests compared between treatment arms. Spearman’s rank correlation coefficient was used to measure the relationship between signatures and cell counts. P-values

      Results:At 96 weeks, the relative abundance of naïve B-cells in CT3.5+5.25mg/kg treated patients was significantly higher vs placebo. Plasma cells {THESE ARE PLASMABLASTS NOT PLASMA CELLS) and class-switched memory B-cells were significantly reduced with CT vs placebo. The M2 macrophage signature was significantly enhanced with CT vs placebo. Cell abundance of both naïve and memory CD4+ and CD8+ was significantly reduced with CT vs placebo. Deconvolution signature scores were positively and significantly correlated with corresponding flow cytometry data (r: 0.68–0.72 CD19+ B-cells, 0.71 CD4+ T-cells, 0.67–0.69 CD8+ T-cells).

      Conclusions:At 96 weeks following CT treatment in Year 2, changes in leukocytes suggestive of a shift towards an anti-inflammatory phenotype were detected

      THEREFORE MEMORY B CELLS ARE PROBABLY GONE FOR 2 YEARS SO MAY BE.

      REAL WORLD VIRAL HERPES ZOSTER INFECTION
      3352 reports met our inclusion criteria. Annual report rates [mean (SD)] were highest for patients treated with NAT 81.9(91.9), and lowest for GA 2.1(2.5). Other DMTs: FIN 70.3(27.3); DMF 66(21); OCR 55.3(27.8); ALE 22.8(15); INF 22.6(18); TER 10.4(4.7). Reports were 4.7x more in females (ranging from 2.3x for ALE to 8.2x for IFB). The highest percentage of reports was in the sixth decade of life for all DMTs except ALE (fourth decade). Several reports were in individuals younger than 40 (25.0%).

      • Many non-COVID-19 studies are ongoing. All are industry sponsored with remote monitoring capabilities. I’m managing 3 phase II oncology studies. Hard to stop treatment and visits given the associated risks. Most MS trails I’m aware of have been paused. Surely there is a work around???

    • WRITING PAPERS ON THE TO-DO LIST yes we will but in some cases we had to leave the data at work we were given a few days to lock up shop. I took the hard disks out of some computers but need a caddy to be able to read them

  • Do you have this statistic? Lymphocyte count when a patient is initially admitted for covid-19 VS the consequences of the disease (moderate, severe, lethal). This seems like a 101 thing to do.

  • I was supposed to be going from Copaxone (been on it one year) to Ocrevus. Screening bloods taken, then literally the next day told it was being postponed because of Covid

    Can you see much likelihood of me ever starting it? 2 MRIs from the past year are showing new inflammation,

    After reading Prof G post from this morning I am wondering if there is even any point in my staying in the house for 12 weeks when he thinks 4/5 of us all are going to get Covid in any case.

    I have a 91 year old relative with breast cancer/cancer just taken off back/heart failure/almost blind/almost deaf whose 70 yr old daughter died of cancer last year and I’ve had to say I can’t help anymore (2 other family members are helping her, but they are gruff men!) and she is really struggling me not helping her (a woman’s touch).

    Should I just help her……..she likely won’t be here at the end of the year anyway, she’s given up….

    • I cant say when you will start but within a couple of months we will be in a different place as we will probably have a better idea of how to treat COVID with available drugs and we will have a history of pwMS and others who have got through COVID19 or not.

  • Not directly ms related.
    I can’t understand, Profs.
    People produce antibodies in response to viruses.
    Other people can easily clone them to produce MAbs, I read in this blog.
    Why there is no mabs against novel coronavirus still produced?

  • I have been on tecfidera since 2013. My lymphocyte count has been recently hovering around 80 K/uL but as low as 69 in 2018. My most recent lab work shows me positive for the JC virus for the first time since 2015. All other results have been classified as indeterminate. My JCV index is .51

    I am trying to find my risk of developing PML. I searched this site but it appears most of the posts dealing with DMF and PML are dated to 2015 and prior.

    It was supppse to have a neuro visit but ewas as cancelled last month due to the pandemic

  • I had my first round of alemtuzumab July 2019. Is there any hope that I will be able to get my second round of alemtuzumab done say this fall or indeed ever? And roughly when do you expect such immune reconstruction treatments to continue? And what are the downsides for having a 2-3 month vs 12ish month delay depending on how this pandemic plays out? I am worried that a full year delay so 2 years between rounds would be problematic but maybe I am mistaken and it would be fine? Would I have to self-isolate for longer, say 3 months strictly? At what point of decline of COVID in the UK population (or does it matter say if they detect antibiodies for COVID such that I’ve already had it) is it safe to start HSCT or alemtuzumab (or Ocrevus) again. I’m worried about my MS declining with the halt on these more aggressive and effective therapies. I don’t want more permanent brain damage and/or disability. I also don’t want death by COVID, what do MSers like I do in the meantime?

    • There is data from Cambridge of 18 months from first infusion so 6 months delay is probably OK, but remember some people fail alemtuzumab. In the next month or so it will become clearer what has hapened to pwMS with COVID, you would be at risk 1-3 months after alemtuzumab and after the drug is gone after one month and your cells start to return, notably those that will give you anti-viral protection. If you have had COVID you should be immune.

      • My follow-up to this is if you have had COVID and are immune, does that immunity apply when you are high risk in that 1-3 months post alemtuzumab? Or are you not immune during that time and then immune again once your cell start to return. And yes, and I have read I think here that there is now a test to know if you are failing alemtuzumab or not? Besides just waiting for further progression? I am being treated in the UK so would love to know if that will be available. So far *fingers crossed* I’ve been very stable since my first infusion last summer.

        • Stable …Very happy

          Test of failing alemtuzmab or not…Not sure. Our test may suggest you will fail but that is if you have anti-drug antibodies, please get your neuro to contact us for this test prior to cycle 2 or more if interested. We have tested people from London, elsewhere in UK and from the USA by overnight post.

          I suspect that if you are immune you will stay immune: (a) Alemtuzumab may not be a great plasma cell depleter, based on CD52 expression and (b) basedon the suggestion that it may not purge the bone marrow. However the CD8 response may be blunted.

  • Although this questi9n is related to COVID 19 it is indirectly asking about virusus. Given COVID 19 has jumped species again and infected tigers and lions from a human handler. I don’t know of any previous epidemics that spread to humans then started affecting animals from human. My question is doesn’t this set a dangerous precedent? Is so what are the implications? Global death including all mamals?

    • I dont think it is all mammals. We know that COVID infects via ACE2 receptor. If we look at the virus and how it targets ACE-2 it is cat adapted, hamster adapted and perhaps scarily bovine (cattle) adapted. It is all based on biology

      • Thank you MD. Just want to know the science. If tigers are affected are chickens affected. Can I eat meat and still power lift. At least in this lockdown we started 4 weeks ago on.my insistence
        I can start using my fully equipped gym at the back of my garden.

  • Numbers

    27 650 000 $ (in 2019)

    2 304 166 $ (each month)
    78 805 $ (each day)
    3 200 $ (each hour)
    53 $ (each minute)

    Thats what Merck CEO Ken Frazier made last year 🙁

    https://www.fiercepharma.com/pharma/merck-ceo-ken-frazier-gets-32-pay-bump-strong-keytruda-sales-cancer-m-as?mkt_tok=eyJpIjoiTjJObVlUZGhZelE0TWpCaiIsInQiOiJSb1VPeGJnWktlQ2JWM1VQNkFqRVwvNGQyTVlIMXhGaXhpbHFheWRzdlhNbXBBak1meGUrcTN1czNnWkpnNlFlSVVWTzIybWp6cGhUYmlGV2pxQXRtOTBaUVpMUTFBTXZEVmlWWTFOak1cL0puZTRyZHByWVVWVXlxWWRPNEM4ZlhRWlVTUDBIVmRjY3g5RWFLQnRyYnRDUT09In0%3D&mrkid=82988002

    For comparison

    What is Cristiano Ronaldo’s salary?

    Ronaldo’s contract at Juventus is believed to be worth €30m ($34m/£26m) a year,

    https://www.goal.com/en-gb/news/what-is-cristiano-ronaldos-net-worth-and-how-much-does-the/wpqwcm08p2o916g11efo6et6z

    Enfim

    Its one BIGGGGGGGGGGGGGGG

    PARTY

    • The is American Merck (Merck Sharp Dome) and nothing to do with the German Merck making MS drugs. These crazy salaries of CEO are part of the pharmaceutical pricing problem. The CEO can do a shit job and still get paid at a ridiculous level. CEO wage inflation is not just the realm of pharmaceutical companies…not a back gig if you can cope with it

  • Two questions – one hard, one hopeully less so:
    1) Do we have good estimates on the relative efficacy of the newer DMTs (I know there are no real RCTs comparing them head to head)?
    2) After how many cycles is ocrelizumab assumed to reach its full efficacy (the rebaselining in the studies makes me suspect not after the first one)?

  • Is it ok to have air in the IV drip during Alemtuzumab administration or the saline flush? Or can this cause any issues?

  • Hi MD/Prof G,
    How does dyspnea appear in someone with MS who has brainstem lesions (in the pons definitely, but no MRI was done). Would this cause difficulties with taking a deep full breath or feeling like you just can’t go all the way when you breathe in and take a full inhalation?

  • What causes the sensation of the brain performing forward rolls in the head, like when you go over the brow of a hill in a car and your stomach lurches?

  • When someone says that antioxidants are of no use show them this paper

    Progressive ms

    Fibrin

    Glutathione

    Acivicin

    Microglia

    Toxic cell atlas guides new therapies for neurodegeneration

    https://medicalxpress.com/news/2020-04-toxic-cell-atlas-therapies-neurodegeneration.html

    Ps: This study as Katerina Akassoglou as co author she won the 2018 Barancik Prize for Innovation in MS Research

    Ps2: Lipoic Acid is brain penetrant it reduce by , glutathione reductase and it salso use in Ms

    Obrigado

    • PS3. Thanks I will have a look when it surfaces, its not in Nature Immunol website yet…interested to see what this progressive model is….same old mushroom food I suspect…Lipoic acid…trial planned…glutathione..Mark Noble, then UCL had the idea about 30 years ago and we did the N acetyl cystine experiments…it did nothing but we didnt understand the difference between progression and relapsing disease then…also N acetyl cysteine was supposedly poorly CNS penetrant, we tried to get hands on CNS penetrant version from israel…but no joy

  • Growing new neurons after injury

    When damaged, the adult brain repairs itself by going back to the beginning

    When damaged, the adult brain repairs itself by going back to the beginning

  • Please can we have a Covid 19 free week? Perhaps next week? The TV news, news papers etc. are 100% Covid 19. I want this website to get back to MS issues. Those of us with MS are well aware of what we should be doing – MS Trust website, MS Society website….

    The AAN Conference should have been taking place at the end of this week. I see that Sanofi is announcing results of a trial on Thursday:

    https://multiplesclerosisnewstoday.com/news-posts/2020/04/20/sanofi-detail-trial-results-sar442168-oral-relapsing-ms-therapy-online-session/

    I’m assuming other pharma companies and research teams will also be publishing stuff.

    Let’s end the lockdown on MS posts and move away from the endless Covid 19 posts. Hopefully, Covid 19 will have passed in 12 months. MS will be with us for the rest of our lives.

    • Yes a good point…I will trawl through the AAN abstracs and do some posts, I have already done a few like our one on alemtuzumab antibodies, but this will be a good one CNS BTK inhibitor will it be better than evabrutonid. I’ve signed up. As for end of COVID stuff…fat chance because there is information that will be relevant…we will soon get the first wave of disease related publications

      • Mouse,

        Thanks.

        “As for end of COVID stuff…fat chance because there is information that will be relevant…we will soon get the first wave of disease related publications”

        It’s a pity MS researchers can’t pump out so many papers so quickly!

        Please remember that the only real Key Workers are Locksmiths.

        • Sad the MS can’t pump them out….just wait and see…European lock down occurred a month and a half ago, if it takes a day to a week to write a nothing paper….1-3 months to review on a good day. You are in for a treat….we are at the trickle stage…however 95% of the COVID papers are people taking about nothing…will we get gloves, mask, fish on friday, what does it mean for hand surgeons, bus drivers, cats, dogs and ferrets. SOme of the bigger journals have now shut up shop as they published a few garbage papers early on and now they are deluged with medicocrity. They will fill the space with the usual suspects

          However as central governments are throwing money into the COVID pot we will follow.

    • Thanks I started to go there but in the end I have put a link into the work and run…I wonder what will be the consequnce of monocyte targeting, they are doing all the wrong experimetal time points for what we want to know clinically So all of technology pleasing the EAEers

  • Hello Doctors/Experts-
    Thank you for your work. Ocrevus was approved via trials with groups of RRMS and PPMS (yes?). Is there any good reason to believe that Ocrevus would work with secondary progressive cases with no relapses, slow “clinical” progression, and with no active or changing MRI evidence? What is the best guess on this? Is there any scientifically based evidence on this? Thanks, stay safe and good luck. Tom

    • Yes inflammation occurs from the beginning to the end, however it is not going to be the total solution in progressive MS

      • So then, inflammation occurs without any MRI evidence? We’re talking “secondary” progression. I’ve heard (I think) Dr. G speak of inflammation as an indicator of disease rather than the cause. So there can be disease without any inflammation. I think I heard him say that too. I thought Ocrevus was not an anti-inflammatory treatment. So if given no inflammation via MRI, then what? Ocrevus still good despite “stage” of MS? Can you just name a couple hints and I’ll take it from there?

        • You have to think that there are at least two types of inflammation that caused by immune cells leaving the blood and entering the brain which you can see with MRI and inflammation occuring within the brain which the MRI does not see. This is there from the beginning to the end and secondary progression is just a term that relates to loss of neural reserve in the pathway.

        • There is a suggestion that ocrelizumab only.works because it is stopping the inflammation arriving from.blood to brain. I can accept this until proven other wise

  • Ok maybe this wont be post 🙂

    Its 1:36 in the morning and i am going through all the Aan 2020 abstracts (once agian)

    And came across the study

    Identification of Therapeutic Lag in Multiple Sclerosis

    Which in itself is just another tool for (whatever) 🙂

    Now what i have never seen is the spectacular mega list of
    Author Disclosures

    Its truly amazing

    🙂

    129 lines (hope to count that right)

    Identification of Therapeutic Lag in Multiple Sclerosis

    https://index.mirasmart.com/AAN2020/SearchResults.php?Topic=MS+and+CNS+Inflammatory+Disease&Author_Institution=&Author=&Title=&pg=7

    Author Disclosures:
    Dr. Roos has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Merck, Roche, and Novartis. Dr. Leray has nothing to disclose. Dr. Frascoli has nothing to disclose. Dr. Casey has nothing to disclose. Dr. Horakova has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen, Merck, Teva, Roche, Sanofi Genzyme, and Novartis. Dr. Horakova has received research support from Biogen Idec. Dr. Havrdova has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Actelion, Biogen, Celgene Corporation, Merck, Novartis, Roche, Sanofi, and Teva. Dr. Havrdova has received research support from Czech Ministry of Education, project PROGRES Q27/LF1. Dr. Trojano has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with scientific Advisory Boards for Biogen, Novartis, Merck Serono, Roche and Genzyme has received speaker honoraria from Biogen Idec, Sanofi-Aventis, Merck Serono, Roche, Teva, Genzyme and Novartis and has received research grants for her Institution from B. Dr. Trojano has received research support from Dr Trojano received research grants for her Institution from Biogen Idec, Merck Serono and Novartis.. Dr. Izquierdo Ayuso has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Bayer, Biogen-Idec, Novartis, Sanofi, Merck-Serono, Almirall, Roche, Actelion, Celgene, and Teva. Dr. Eichau Madueno has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen Idec, Novartis, Merck, Bayer, Sanofi Genzyme, Roche, and Teva. Dr. Patti has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with received personal compensation for speaking and/or advisor board activities by Almirall, Bayer, Biogen, Celgene, Merck, Myalin, Novartis, Roche, Sanofi-Genzyme and TEVA.. Dr. Patti has received research support from received grant research by MIUR (Ministero Italiano della Universit& #224 e della Ricerca Scientifica), FISM (Fondazione Italiana Sclerosi Multipla), Biogen and Merck.. Dr. Onofrj has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with GlaxoSmithKline, Novartis, Lundbeck, Eisai, Valeant, MedTronic, and Newron, Zambon, the World Parkinson Congress, the Movement Disorder Society, and the Atypical Dementias congress was an invited guest and lecturer for the Mental Disorders in Parkinson D. Dr. Onofrj has received personal compensation in an editorial capacity for Medicine. Dr. Onofrj has received research support from Italian Ministry of Health and the Italian Ministry of Education.. Dr. Lugaresi has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Advisory board member (Bayer, Biogen, Merck, Novartis, Roche, Sanofi, and Teva) and speaker honoraria, travel expenses (Bayer, Biogen, Merck, Novartis, Sanofi, Teva, and Fondazione Italiana Sclerosi Multipla).. Dr. Lugaresi has received research support from Research grants (Bayer, Biogen, Merck, Novartis, Sanofi, Teva, and Fondazione Italiana Sclerosi Multipla).. Dr. Prat has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Received honoraria and operating grants from most pharmaceutical companies. Dr. Prat has received royalty, license fees, or contractual rights payments from Elan and Prothena.. Dr. Prat has received research support from Roche, Biogen and EMD Serono.. Dr. Girard has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Teva Canada Innovation, Biogen, Novartis, Genzyme Sanofi, and EMD. Dr. Girard has received research support from Canadian Institutes of Health Research. Dr. Duquette has nothing to disclose. Dr. Ozakbas has nothing to disclose. Dr. Grammond has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen, Novartis, Teva Neuroscience, Merck Serono, and the Canadian Multiple Sclerosis Society. Dr. Sola has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with honoraria as a speaker or advisory board member from Bayer Schering, Biogen, Genzyme, Teva. Dr. Sola has received research support from Bayer Schering, Biogen, Genzyme, Merck Serono, Novartis, Sanofi, Teva. Dr. Ferraro has nothing to disclose. Dr. Bergamaschi has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Bayer Schering, Biogen, Genzyme, Merck , Novartis, Sanofi-Aventis, Teva. Dr. Bergamaschi has received research support from Almirall, Bayer Schering, Biogen, Genzyme, Merck , Novartis, Sanofi-Aventis, Teva.. Dr. Boz has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen, Novartis, Bayer-Schering, Merck, Teva, Sanofi Aventis, Roche. Dr. Cartechini has nothing to disclose. Dr. Sa has nothing to disclose. Dr. Terzi has nothing to disclose. Dr. Alroughani has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Bayer, Biogen, Biologix, Merck, Novartis, Roche, and Sanofi. Dr. Alroughani has received research support from Biogen, Merck, Novartis, Roche, and Sanofi. Dr. Grand-Maison has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen, Genzyme, Novartis, Teva Neurosciences, Mitsubishi, and ONO Pharmaceuticals. Dr. Granella has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen, Novartis, Merck, Sanofi-Aventis, and Roche. Dr. Granella has received research support from Biogen and Sanofi Aventis. Dr. Iuliano has nothing to disclose. Dr. Hupperts has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen, Merck Serono, Sanofi Genzyme, and Teva. Dr. Hupperts has received research support from Biogen and Merck Serono. Dr. Lechner-Scott has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Accepted travel compensation from Novartis, Biogen and Merck KGaA. Her institution receives the honoraria for talks and advisory board commitment from Biogen, Celgene, Sanofi-Genzyme, Merck KGaA, Novartis, Roche and Teva.. Dr. Lechner-Scott has received personal compensation in an editorial capacity for I am a chief editor for MSRAD and receive $3000 per year as compensation.. Dr. Lechner-Scott has received research support from Institution receives research grants from Biogen, Celgene Sanofi-Genzyme, Merck KGaA, Novartis, Roche and Teva.. Dr. Spitaleri has nothing to disclose. Dr. Van Pesch has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with My institution has received consultancy fees from Roche, Sanofi, Biogen, Merck, Novartis. Dr. Van Pesch has received research support from Research grants from Roche, Novartis and Sanofi.. Dr. Soysal has nothing to disclose. Dr. Prevost has nothing to disclose. Dr. Aguera Morales has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen, Sanofi, Teva, and Bayer. Dr. Olascoaga Urtaza has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen, Novartis, Sanofi, Roche, Almirall, Bayer, Sanofi, Merck. Dr. Olascoaga Urtaza has received research support from Biogen, Merck , Novartis and Teva.. Dr. Turkoglu has nothing to disclose. Dr. Sidhom has nothing to disclose. Dr. Gouider has nothing to disclose. Dr. Van Wijmeersch has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Bayer-Schering, Biogen, Merck Serono, Novartis, Roche, Sanofi, and Teva. Dr. Van Wijmeersch has received research support from Bayer-Schering, Biogen, Merck Serono, Novartis, Roche, Sanofi, and Teva. Dr. Butzkueven has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Institution (Monash University) received compensation for consulting, talks, advisory/steering board activities from Alfred Health, Biogen, Genzyme, Merck, Novartis. Dr. Butzkueven has received research support from Research support from Biogen, Merck, MS Research Australia, National Health and Medical Research (Australia), Novartis, Oxford Health Policy Forum, Pennycook Foundation, Roche. Dr. Malpas has nothing to disclose. Dr. Vukusic has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen, genzyme, Novartis, Merck. Dr. Kalincik has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with TK served on scientific advisory boards for Roche, Genzyme-Sanofi, Novartis, Merck, Celgene and Biogen, steering committee for Brain Atrophy Initiative by Genzyme, received conference travel support and/or speaker honoraria from WebMD Global, Novartis, Bi. Dr. Kalincik has received personal compensation in an editorial capacity for TK has served on the editorial board of Multiple Sclerosis Journal, as an associate editor for BMC Neurology and reviewing editor for Frontiers in Neurology.. Dr. Kalincik has received research support from Biogen.

    Its a real BIG BIG Pharma out there

    Obrigado

    • There you have it the list of disclosures is longer than the abstract, it seems the world is so sh1 scared that you are being misled by those terrible scientists. However with such long lists of disclosures you are being misled because the real conflicts of interests are being lost in a sea of irrelevant relationships….However does it mean you are abit SH1 if you don’t have any because it means pharma isn’t interested in your thoughts. You go to ECTRIMS and people show the disclosures in nano seconds, but they should say in big letters these slides were made by pharma for me and I am being a paid mouthpiece….thats a disclosure. Look at the poster and you see if it is in a standardised colour/format it was made by the pharmaceutical company and not the presenting authors.

      • Until they disclose the actual amounts in $s for money that went into their actual bank account (rather than the bank account of the academic institution or research department) it’s difficult to draw any conclusions ie if it was a few thousand $s a year, you may think that’s okay. If it was $25k+ a year you’d maybe start questioning the motive of the person ie is their work about improving the lives of patients or filling their boots (bank accounts). Perhaps a job in the City would have suited them better.

        • I am sure they do disclose it….to the Taxman :-), Is someone who does private practise different from someone who consults for Pharma, I think the former is one of the reasons why some many consultants were forced to retire.

        • Half way trought the 129 lines

          Dr. Lechner-Scott has received personal compensation in an editorial capacity for I am a chief editor for MSRAD and receive $3000 per year as compensation.

  • Could I please ask…
    In your opinion, might ibuprofen play a helpful role in ameliorating elements of inflammation associated with progressive MS?

    • You may be right but in this environment no-one will do there, I would do a quick search on ibruprofen and COVID there is a massive literature on the use of ibruprofen or the advice not to use it. For Fever take paracetemol

      • Yes, can understand that. I have to say I become more and more convinced that it helps my slow PPMS, a lot even… But of course, I have no qualification to recommend to others (especially right now). However, it’s the one medication I have.

    • Looks encouraging and the MDs were on the right track in suggesting looking at BTK inhibitors a while back., rather than a press release. Need to see the data when it’s published.
      Also not sure about the propspect of these being used long term as disease modifiers but as a short term course to get rid of plasma cells and oligoclonal bands in the CNS is the way to go in my opinion.

      • MD2,

        Thanks

        How does it fit in with Prof G’s smouldering MS hypothesis ie would getting rid of plasma cells address smouldering MS?

  • Covid 19

    Forget about antibody test

    COVID-19: New model predicts its course, resolution and eventual good news

    Professor Nicolau and his colleague Alex Hasson, who is leading the data collection for the project, used their model to project an approximate final death toll in hospitals and care homes of 35,000 for the UK, 75,000 for the US but substantially less than 1,000 for Australia, most likely in the low hundreds, by the end of 2020 (barring another major wave).

    https://medicalxpress.com/news/2020-04-covid-resolution-eventual-good-news.html

    Lets hope it holds up

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