ArchiveJune 2020

NICE not so NICE again

Siponimod is not recommended, within its marketing authorisation, for treating secondary progressive multiple sclerosis with evidence of active disease (that is, relapses or imaging features of inflammatory activity) in adults. Interferon beta-1b is currently the only disease-modifying treatment available for people with active secondary progressive MS. However, NICE says that few people take it...

Alemtuzumab exposes lots of interesting biology. #MSCOVID19 The macrophage is important for getting rid of SARS-CoV-2

Yesterday we (MD1&MD2) and others (MS researchers) were accused of being responsible for the downfall of alemtuzumab with the regulators. This is because they (other MS researchers) have drip-fed reported adverse events like these: Immune-mediated hepatitis induced by therapy with alemtuzumab in a patient with Multiple Sclerosis. Bolte FJ, Schmidt HH, Schlevogt B.Hepatology. 2020...

Alemtuzumab Epiphany

Prof G is in a melancholic mood. Why? This week I am doing video consultations with all the volunteers who participated in the pivotal phase 3 and 10-year extension studies of the alemtuzumab clinical trials. My objectives are three-fold. Firstly, to make sure they are referred back into a routine NHS MS service and are not left floundering without follow-up. Secondly, to complete a few exit EDSS...

Providing Energy to Nerves Saves them from Damage

Read Licht‑Mayer et al. The brain is very energetically active and consumes a large amount of energy. This energy is made in small organelles inside the cells called mitochondria. There adenosine triphosphate ATP, which is a unit of cellular energy, is made. During demyelination the mitochondrial move to areas where myelin is lost as it takes alot of energy to keep the nerve firing. If they...

The #MSCOVID-19 vacccination window of ocrelizumab/rituximab and more evidence for the importance of memory B cells

Want the Quick Read. Do the stuff in Red! (SEE NEW PAPER AT THE BOTTOM) How long does it take for the vaccination window to open?DOI: 10.22541/au.159292858.82650822 As you know our initial paper on COVID-19 took a look at the biology of COVID-19 and its relationship to MS disease modifying drugs. How do MS drugs affect COVID-19. Read this paper. The answer, I think is not alot. Baker D, Amor...

COVID-19 has changed neurology

I generally don’t like to rock the boat on anything, this applies to what I wear, eat, the people I co-locate with and work. It should therefore come as no surprise that my response to our changing practice if anything luke warm. I understand fully (more so than you may credit) the impact that COVID-19 has had on hospitals, and continues to do so. But, in my opinion this should be temporary...

#MSCOVID19 two swallows don’t make a summer

As you know I have had to backpedal with my SARS-CoV-2/COVID-19 advice in relation to anti-CD20 therapies. I have now had to reinterpret data on the role of immunoglobulins in protecting people from developing COVID-19 and severe COVID-19. I have been using the two Italian cases of X-linked agammaglobulinaemia who got COVID-19 and make a recovery as an argument that you don’t need B-cells and...

Ocrelizumab vaccine Readiness part 2

Attenuation of antibody response to SARS-CoV-2 in a patient on ocrelizumab with hypogammaglobulinemia. WL ContePublication stage: In Mulr scler rel disord. DOI:  A 48-year-old on ocrelizumab (last dose 1/24/2020) presented to a drive up COVID-19 testing site with two days of fever, upper respiratory symptoms, and malaise on March 30, 2020. They tested positive for the antigen to SARS-CoV-2...

#MSCOVID19 when the theorectical becomes a reality…CD20 and vaccine readiness

ProfG caused a stir when he suggested that people taking anti-CD20 may be at a small increased risk of developing COVID-19. However, would we expect this?. If it makes a small increased risk of other infections. why not this one? However, the other reality that we could predict ,was that if you have no B cells it is going to be more difficult to make antibody responses to SARS-CoV-2. In this case...

#MSCOVID: updated international guidelines

The MSIF has just updated its COVID-19 International MS guidelines. What do they know that we don’t? Advice regarding disease-modifying therapies for MS Many disease modifying therapies (DMTs) for MS work by suppressing or modifying the immune system. Some MS medications might increase the likelihood of developing complications from a COVID-19 infection but this risk needs to be balanced...

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