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Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

27 comments

  • Prof G I note you have demoted anti-CD20 down the list of DMTs on your MS-Selfie spreadsheet. Is this based on this Swedish data?

      • But when this data originally came out you didn’t think it changed anything about ocrelizumab, why the change?

        • New data which indicates that immunity to other coronaviruses (cause of the common cold) may be cross-reactive against SARS-CoV-2 and hence reduce your risk of getting COVID-19, severe COVID-19 and from dying of COVID-19. It is likely that anti-CD20 therapies will blunt this response. In other words, there is now some biological or scientific plausibility to explain the Swedish data, which I can’t ignore.

  • Well, for a patient on ocrelizumab this is highly depressing.

    Is this new data from Sweden or is the same he reported before? If I remember rightly we were told the chance of getting covid on anti CD20 May well be increased, but the risk of severe covid was not. And even then we were told it was likely biased info. All along we have been aware the innate immune system is key in fighting covid.

    Now we are told actually yes you may be at risk of more severe covid.

    Is this risk the same for someone who has been on anti CD20 for less than a year as someone who is more long term depleted?

    Are you still dosing with ocrelizumab? Should I be missing my next infusion as clearly this suddenly seems to be the duff choice for anyone worried about covid.

    I watch IWIM every week and even this week they again showed no signal for any DMT.
    I have been given the green light from work to return in some way (as a HCP) and I felt the data was supporting that. Now I feel suddenly am I going to have to undo all of that?
    Do we not have enough info now to say there is no signal for any DMT?

    • Jan Hillert did a report on the risk of rituximab and COVID and suggested that it may be possible that there is selection bias. As for risk of severe covid I am not sure this is supported.

      If you are long term depleted I think is different from first dose because with time you are depleting the pool of cells making antibody

      • Thanks. I have been on ocrelizumab for 9 months in total (so initial two halves and then my first full dose 3/12 ago). Can I assume the importance of cross cover corona antibodies is less for someone like me

  • Has Roche released new data sets for PwMS on ocrelizumab? It seems it was quite a while ago that they released the initial numbers. Do we have an expectation of when they might update us?

    • No aware of any new data sets except data from the French register that is due to be published. If I recall correctly there were too few patients on any of the DMTs to give a clear signal.

  • It’s hard to know what to do about continuing ocrelizumab. I was due 2nd full in May but it’s rescheduled to July. Do I continue or not? I thought Prof G continued dosing his patients throughout.

    I’ve also been advised to continue shielding for another month after but they’ll check lymphocytes to guide this.

  • Can somebody please explain this to me:

    Are they saying patients who had never had covid (presumably confirmed serologically to have never been exposed?) had antibodies to it? And that these were probably antibodies from a different common cold?

    And as for anti CD20 – if you have a dose, does it wipe out all the antibodies you have ever previously developed to infections in your life? So common colds you had before anti CD20 would all be wiped away? Or does it just wipe out any new antibodies from being made to any infection you are exposed to AFTER your treatment?

    • Yes there are 4 main strains of coronaviruses that cause the common cold, if you have been infected with these you make a T cell responses and that gives you some protection against COVID-19. There may be some

      If you have anti-CD20 it does not touch the antibodies as antibody making cells do not have cd20 on them so if you have made e.g childhood immunities they will remain. With time antibodies levels may start to drop abit

  • How about leaving it up to the patient to decide if they want ocrelizumab, this risk averse stupidity is like not crossing the road because of the 0.00004% chance I might get run over. I would rather take my tiny chance of actually getting the virus than risk permenant disability by taking an inferior drug.

    • In the literature there are about 400 cases of people on an anti-CD20 getting covid-19 there were about 6 deaths in the reports I looked at. Is this because there is more risk of infection on CD2- therapy the iranian study says yes the swedish study may say yes, the french study may say no

  • Did post this earlier but don’t know where it went.

    It’s hard to know whether to continue ocrelizumab or not? My 2nd full due in May has been rescheduled for July but do I stop it in view of the risks? I thought Prof G had continued dosing his patients throughout so he must think the benefits outweigh the risks.

    • I am also interested to know the answer to this. Hopefully Prof G comes back and addresses some of these issues following this video!

  • The flipping goalposts change every flipping few weeks!

    People’s heads are confused enough to start with with regards to what “medicine” they are putting in their body to try and stave off disabilities.

    I’m losing the plot with all this backwards and forwards…..I am starting to think the LESS you know the better, not the other way round.

  • Thanks for the update. Food for thought for all on anti CD20…. should I stay or should I go?

    re blogging or vlogging, either good, as long as listed here easy to search and find in future.

    • Easy to search..sorry, this was supposed to be one of the reasons for moving from blogger…but this search function is eaqually crap

      • No it‘s not! Your Search function is great (or at least just as good as whatever your software vendor promised to you) and I use it a lot. Thank you.

        Anyways, the point of lacking searchability with increased usage of vlogging is valid. I would therefore greatly appreciate if you/ProfG try to compensate by paying more attention to tagging and mentioning any salient points as hashtags below the video.

        Thanks!

  • I have 2 questions!

    1) Is everyone who doesn’t have these cross cover antibodies destined to get severe disease? Or can you still fight it fine without them? Perhaps this is where risks such as co morbidities come in etc

    2) Why then are children not more infected? (Haven’t had as much exposure and therefore antibodies to many other colds)

  • Great to see video, nice to listen in the background when you don’t want to look at screens. Also watched your other video about thoughts on Covid/MS services. Very interesting and hope everything doesn’t go backwards… especially for new patients. My sisters MS became quite active all of a sudden during covid, she got put on Tec and was given no other choice or option. The hospital wouldn’t offer the stronger ones. Doesn’t seem like the best option when you have 2 relapses in quick succession and can’t see out of both eyes… fingers crossed if it doesn’t help the stronger ones will be back on the table..
    It really should still be up to patients to take our own risks with treatment, whichever amount we are comfortable with. Not just with MS but any illness. Does this put more on the doctor though? In terms of risk for you as a professional? It would be interesting to understand that side of things.

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