Natalizumab – new insights

N

I view the field of MS as being ‘Before Natalizumab or BN’ and ‘After Natalizumab or AN’ this vlog provides another important insight we have obtained from the reanalysis of the data from the original phase 3 or AFFIRM study.

CoI: multiple

About the author

Prof G

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

17 comments

  • Thanks for that. 2 question please:

    1) where do we stand with regards to neuroprotection add-on therapies trials?
    Are any recruiting yet?

    2) Is it possible to segregate a subgroup of patients in AFFIRM 3 who were treated early with natalizumab in the course of their disease (good responder) and track their inflammation (new lesions + NFL levels) overtime and most importantly assess their rate of conversion to SPMS?

    Tony F

    • 1) COVID-19 = No…Oen of he fall outs of this are many trials have been put on hold/delayed…the MS Socieites have massive funding holes they will plug this by not funding rersearch, fewer trials fewer ideas

      • But they’ve spent millions on trials (e.g. Cupid) in the past without success. I fear Covid 19 will be used as an excuse for the failure to find effective neuro-protective, remyelination and neuro-restoration therapies when the real failure (by all MS research teams) is to fully understand the disease and come up with effective therapies based on the real disease.

        • We are working on it; as always we need grants/money, time and pwMS willing to participate in research trials.

        • Actually, closer examination showed that the CUPID trial was successful in the subset of PWMS where it was possible to show a positive effect as opposed to those who were enrolled but too far advanced in their EDSS to show anything over the time period of the trial. However calls for this to be repeated with more rigorous enrolment criteria have fallen on deaf ears.

          • In fact this would be the surest and quickest route to finally getting a neuroprotectant for MS.

          • But if the CUPID trial was successful in a subset we already have evidence for a neuroprotective for a subset!!! Why do we need another many-years-trial to repeat this?

  • Thank you very much ProfG – once again an incredibly informative post/video.

    I’ve been on tysabri, which has completely switched off inflammation. Where to go now? There is no neuroprotective drug, is there?

    Also, what’s your strategy to derisk JCV+ve patients? Is EID enough or do you suggest switching treatment?

  • Prof G,

    But why are lymphocytes entering the brain? Surely this is the most fundamental question to answer! Is any research team trying to answer this question?

    • Lymphocytes travel all over the body all the time. They are the reconnaissance division of our the immune system. Lymphocytes are looking for infections and tumours. Stop them travelling or migrating and you get infections (e.g. PML) and tumours (e.g. CNS lymphomas).

    • They do enter the brain normally, just at a much lower level than is seen for the rest of the body. As Prof G notes, shut it down completely and problems emerge.

      • But surely the fundamental question to answer is why lymphocytes are entering the brains of people with MS at a higher rate than for non-MSers? The brain bank, more powerful MRIs and analysis of blood / CNS fluid never answer this question. Is it just too difficult or are we not looking at those things that may provide the answer?

        • Lymphocytes entering are either being “called to action” to fight an infection in the CNS or the BBB is becoming more permeable due to idiopathic inflammation. Why? That is the question. Personally I would like to see antivirals being tested more aggressively.

    • Lymphocytes go every where, don’t see a target they can die and we can make some more or they could leave and go elsewhere they have a limited life span

  • How can we facilitate this type of analysis of trial data of other MS drugs? I feel this should be fairly straightforward if the raw data already exists but I fear it won’t happen actually happen …..

  • How can we facilitate this type of analysis for the other MS drugs? I feel it should be quite straightforward if the raw data exists but I fear it won’t actually happen …..

  • Hi Prof G, as a PwMS who has been on Natiluzimab for 3 years now I’m super happy with it and just keep praying I stay JCV neg until more advances are made in the other fields you mentioned. Really appreciate you making videos and posting info for PwMS. Thank you, Trudy

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