The Great Debate at the Neurology Academy


The ABN guidelines are suggesting that most high efficacy DMTs are treated the same. The MS Academy hosted a debate on 31 March 2020 to discuss whether ocrelizumab and cladribine should be treated in the same way as alemtuzumab in terms of risk of #COVID19.

Alemtuzumab = cladribine = ocrelizumab

If you have an hour on your hands the debate between ProfK and ProfB is here.

COI: Multiple

Apologises to ProfK for using the national stereo for the sake of levity

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  • Kinda feel whatever the debate this is the bottom line and it supports Neuro Doc Gnanapavan saying two days ago: ‘This is most definitely War’ and ‘I would like all our MS patients to take full precautions no matter how fit you maybe.’

    Implications of all the available evidence
    Our estimates of the case fatality ratio for COVID-19, although lower than some of the crude estimates made to date, are substantially higher than for recent influenza pandemics (eg, H1N1 influenza in 2009). With the rapid geographical spread observed to date, COVID-19 therefore represents a major global health threat in the coming weeks and months. Our estimate of the proportion of infected individuals requiring hospitalisation, when combined with likely infection attack rates (around 50–80%), show that even the most advanced health-care systems are likely to be overwhelmed. These estimates are therefore crucial to enable countries around the world to best prepare as the global pandemic continues to unfold.

    This is from a study in The Lancet published on the 30th March concerning the severity of the coronavirus.

    • It is still extremely helpful to those of us in isolation because of a DMT, to know that there is a potential glimmer of hope. Nobody said it is not a global emergency I think that is clear by now! It also doesn’t mean the issues being debated are not relevant or important.

  • I saw on the web that Covid-19 can cause neurological symptoms. Encephalitis and mental changes.

  • Thanks this will be helpful come June to discuss second round (first full dose) of ocrelizumab with my neuro. (on a side note, I am always a bit unsure when people talk about the second dose, that does refer to the first full dose, right?)

    So far I am very much of the opinion that I want two good ahead with it – presumably small risk increase in case of a second wave seems like a fair price to avoid a substantially higher risk of disease progression.

    • Come June I would how the experience will be known
      I’m unsure …me too that’s why I call it a cycle rather than a dose

  • If someone has had full first round of clad, like myself, how long can I delay second round?
    I understand a 6 month delay is allowable but not sure if more?
    I could on that basis wait until May 2021 for second round
    But say I was offered a vaccine in June 2021 could I start second round 2 in July 2021
    Or does no one really know?

    • I guess the data is not really there at the moment. The question is, how does cladribine work? If it is the B cell we know that in the majority of people they are gone at 12 months still, for alemtuzumab they may be gone for 2.5years to as a theorectical it could be a long time, in the CLARITY study I am aware that one person relapsed about 5 years after their last dose. The level of memory B cells are being monitore in the MAGNIFY study, they must be over a year in now and I bet the memory B cells will be down. However The delay for cladribine is imposed by your total lymphocyte levels. By next June there will be a COVID experience which will help inform more

  • Very interesting, thanks for sharing. As a patient the medical legal stuff isn’t something I’d ever think about, maybe I have too much trust in the doctors/just naive. I’d assume this was a bigger problem across the pond, but don’t envy that you guys have to wrestle with that too – that must be really hard. It totally gives an understanding why the decisions are the decisions though.

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