ArchiveAugust 2020

Fingolimod Trial from Years ago surfaces and guess what, the approved dose works…….Amazing

What is the optimum dose for fingolimod? In the early studies I think they used 5mg and 1.25mg and they both worked about the same. So Novartis dropped the dose and guess what? It worked. They dropped it again and guess what?, it still worked , well at least as good glatiramer acetate but not as good as the approved 0.5mg dose according to this trial started in 2012. Why go to all this trouble...

#MSCOVID19 in the UK

Self-diagnosed COVID-19 in people with multiple sclerosis: a community-based cohort of the UK MS Register.Evangelou N, Garjani A, dasNair R, Hunter R, Tuite-Dalton KA, Craig EM, Rodgers WJ, Coles A, Dobson R, Duddy M, Ford DV, Hughes S, Pearson O, Middleton LA, Rog D, Tallantyre EC, Friede T, Middleton RM, Nicholas R.J Neurol Neurosurg Psychiatry. 2020 Aug 27:jnnp-2020-324449. doi: 10.1136/jnnp...

Somewhere to go after alemtuzumab

Autologous hematopoietic stem cell transplantation following alemtuzumab therapy in aggressive multiple sclerosis: A report of three cases.Boffa G, Sbragia E, Raiola AM, Varaldo R, Capello E, Gallo P, Granella F, Mancardi G, Inglese M.Mult Scler. 2020 Aug 25:1352458520914818 The management of multiple sclerosis patients with persistent disease activity under alemtuzumab treatment is not...

Reducing issues with CD20 depletion

What is the optimum dose and dosing schedule for ocrelizumab? We don’t know because the manufacturers haven’t done the studies, but rituximab it seems that we can reduce the dose. A common dose was 1000mg and it was reduced to 500mg. Efficacy was maintained and impotant it reduced the loss of circulating antibodies. This is important as the loss of such antibodies was associated with...

#MSCOVID19 Cladribine

Whilst we are surely bored with case reports of people infected with COVID-19, the registries contain a few more cases, but companies also have monitor adverse events associated in people taking their drugs. I think that Roche have to be congratulated for being quick off the block to report cases of ocrelzumab infected people. They reported the outcomes in 100 people and 26% of the those reported...

Gut microbes and antibiotics

As you know microbiome is my favourite subject,so when this paper came out in a Top Science Comic I thought I better let you have a look as it is your new hope. Gut microorganisms act together to exacerbate inflammation in spinal cords, Nature (2020). DOI: 10.1038/s41586-020-2634-9, www.nature.com/articles/s41586-020-2634-9 Mice were given an antibiotic cocktail that contained ampicillin...

Glatiramer works by targeting the mechansism responsible for MS

The FDA label says “ The mechanism(s) by which glatiramer acetate exerts its effects in patients with MS are not fully understood. However, glatiramer acetate is thought to act by modifying immune processes that are believed to be responsible for the pathogenesis of MS. These processes has changed over time so this paper made me smile Here, they show that GA treatment revives antiviral T...

Journal Club: Early vs. Late or Low vs. High efficacy

You are welcome to watch our online journal club discussing the following paper. Anna He et al. Timing of high-efficacy therapy for multiple sclerosis: a retrospective observational cohort study. Lancet Neurol 2020 Apr;19(4):307-316.Background: High-efficacy therapies in multiple sclerosis are traditionally used after unsuccessful treatment with first-line disease modifying therapies. We...

#MSCOVID19 Breakfast. If you don’t learn from the monkeys you can be a Right Charlie and you have to wash your pants

The media has got your bowels running scarred again as news filters through of a case of re-infection of COVID-19 virus, 4 months after the first bout. The vaccine won’t work and we are all doomed. This raises fear that we are going to be stuck indoors for every. However before we stain our pants we have to look at the information. When this idea first raised its ugly head many months ago...

Neurofilaments: from a two towards a three-layered cake!

We are happy to announce that our new paper on how to use cerebrospinal fluid neurofilament light chain (CSF NfL) in daily clinical practice has appeared online (open access) in the journal of Neurology Neuroimmunology and Neuroinflammation.  In this paper, we have documented how the BartsMS team is already using for more than four years NfL values obtained with a lumbar puncture to advise...

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