ArchiveFebruary 2021

MS and the Inverse Care Law at 50

Barts-MS rose-tinted-odometer: ★ Variation in access to good medical care and better outcomes has never been higher in high-income countries such as the UK. Variation is simply a euphemism for inequality. The MS community in the UK realised this a few years ago, which prompted us to launch our ‘Raising the Bar’ initiative to address inequality in access to healthcare for people with MS living in...

Asking to change the rules for cladribine? It’s already happened !

Fair enough, there has been a build up to this. After all, a couple of days ago MD ProfB explained – again – that whilst both cladribine and alemtuzumab are immune reconstitution treatments (IRTs) with significant long term effects on B cell subsets, particularly the memory B cell pool, this is where their similarity largely ends. Next came ProfG detailing 17 attributes of cladribine...

#MSCOVID19: specifically for NHS England

Barts-MS rose-tinted-odometer: ★★★★★ Early on in the pandemic, I did a blog post on why I thought oral cladribine was the ideal DMT for managing MS (26-April-2020) remotely. I summarised cladribine’s attributes in a simple 12-point list. This list can now be updated to include (1) data on good COVID-19 outcomes in pwMS who have been treated with cladribine, (2) about vaccine readiness, i.e...

Cladribine is not Alemtuzumab-Discuss

During the COVID-19 your neuros have taken the cautious lazy approach> intitially in the UK neuros were told to: Stop, Stop, Stop the high efficacy treatments and cladridine as an immune reconstitution therapy has been lumped together with alemtuzumab due to laziness and a lack of appreciation of the different biologies. Alemtuzumab is not cladribine. Cladribine is in my view one of the better...

ACTRIMS2021:Lymphocyte recovey after DMF

Some people chose dimethyl fumarate and this can cause significant drop in lymphocyte numbers and so this causes a headache for the neuro about switching you to other treatments. If you stop fingolimod or natalizumab disease can rush back (rebound), however with depleted cells they repopulate at a slow rate and so are unlikely to appear all at once and so rebound is less likely and relapses may...

#MSCOVID19: cladribine is being unfairly tarnished with alemtuzumab’s brush

Barts-MS rose-tinted-odometer: ★★★★★ I think the North American MS community have made some mistakes with their COVID-19 vaccine recommendations, in particular, the NMSS COVID-19 vaccine guidelines for cladribine. In view of the immunology of cladribine’s mode of action and new data that is emerging, I would suggest the NMSS considers updating its guidelines.  Lemtrada and MavencladIf...

ACTRIMS 2021: Natalizumab Coffee Mornings could be coming to an end

Part of the Joys of natalizumab are not only the impact of having a highly effective treatment but of having monthly (or six weekly) infusions, where you get to meet the same people each month for a bit of a chat. It is like a coffee morning…perhaps without the coffee. OK, you may think my comic genius is not funny and I accept that but, it does mean you have to hang around hospital for a...

What Einstein forgot: Multiple Sclerosis curbs “spacetime”

We all know that time is relentless and cruel. However, do you believe it ticks at the same imperturbable pace for all of Earth’s inhabitants?  This has been a controversial topic among scientists, and one of Einsteins biggest mindboggles. Newton believed time was absolute “true time”. If the universe was to be frozen, time would tick on regardless (lockdown has taught us this is definitely...

ACTRIMS 2021 Guess what ocrelizumab depletes memory B cells and in doing so gets rid of EBV infected cells

This is a bit of a No-S-Sherlock moment. If you take anti-CD20 antibodies it depleted peripheral blood B cells out of sight. So in this study they look at the CD19 B cell subsets and conclude it depletes naive and memory B cells which express CD20. There is no suggestion that it may work because of this, but if there is no body because it has been blasted with a shot-gun you would not expect to...

I want to see what happens to other people before I have the Jab. Pfizer Vaccine in the Real World

How long do you want to wait. For in this study there are 0.5 a million people per group. Dagan N, Barda N, Kepten E, Miron O, Perchik S, Katz MA, Hernán MA, Lipsitch M, Reis B, Balicer RD. BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Mass Vaccination Setting. N Engl J Med. 2021 Feb 24. doi: 10.1056/NEJMoa2101765. Background: As mass vaccination campaigns against coronavirus disease 2019...

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