Q&A. Its April the First, Not Sure I can make a Joke this year.

Q

ProfG has had an accident. It seems it has given him brain damage, so he is thinking of quitting clinical neurology to focus on gardening, private practice and MS prevention.

We all know 2020 was a shitty year as far as UK MS research goes. Traditionally we and others have made some poor taste joke on this day but, we don’t have to make it up, it has happened with all its consequences for you and us.

A bronze “Nemo”

So if you have a Question here is the spot for you

Sculpture from the East End of London

About the author

MouseDoctor

119 comments

Leave a Reply to Tommyboy Cancel reply

    • Yes the same artist. Nemo is a tiny sculpture, they get way more impressive…..I have done one for each month to december….After you have the brain training of the search….then work out how you pronounce his surname:-). We should have gone to his show last year which was the first day of lockdown.

  • What is the correlation or occurunce of ms and fasciculations? No charitys or ms sites list them as a symptom but i have suffered constantly with them since my first attack and when asking on a charity forum there is thousands of other pwms that also suffer with them. When asking neuros they say no its normally the peripheral nerves that cause fasciculations not the central nerves, so why do so many pwms suffer from them ? Do you think its possible that we all have benign fasciculation syndrome aswell as ms? Or have been misdiagnosed?

    • Most pwMS who complain of fasciculations actually have focal myokymia, which is the firing of a single neuronal unit (multiple muscle units) that you can feel. Fasciculations involve individual muscle units (very few fibres) and in general, you can’t feel them but only see them.

      Focal myokymia is very common something like 70% of normal people have focal myokymia and so do pwMS. It is not pathological and doesn’t require treatment. On the other hand, true fasciculations may need investigation as they can represent sinister underlying non-MS pathologies. But saying that they can also be benign.

      • as a doctor of neurology if you had a patient of ms complaining of frequent twitching of muscles and constant twitching in their tongue and hand what would your first actions be ? could it be induced by high dose steroids ? or other common ms symptom treatment?

  • The impact of new lesions / relapses can play out over a long period i understand. For a patient, is there a point at which you can confidently say you have sustained such an attack i.e. reached your new ‘normal’. I am asking specifically in relation to spinal cord lesions

    • I had my first cervical lesion three years ago and unfortunately I have never fully recovered. Still waiting to reach that “new normal”…..

      The data suggests spinal lesions in males, less than 40 years old, are more likely to experience a worse disease course. (Which is what I think MD is implying with his response) The only silver lining is most data is before high efficacy DMTs. So there is hope.

    • Yes.
      Two qualifications:
      – Anesthesia has somewhat increased risks in MS in general as it’s taxing for an already suffering CNS
      – Risk of infections might be somewhat higher

      • I already had 3 surgeries while having ms. First was without dmt
        Second was on rebif
        Third on natalizumab

        So being on anti cd20 should be safe-ish?

        My other question in separate comment about tattoos probably is answered too..

        (One could question if tattoo is a smart thing to do, but that’s an other ballgame)
        😉

      • I stopped with tattoos when I started with Natalizumab being told that tattoos are dangerous is you are on second level dmt’s.

        Having multiple plaques in my cns and being super handicapped in a wheelchair living in an ms nursery home while still having rrms (or secondary, smouldering) ms, why should i stop doing what i like doing? Being super handicapped in a wheelchair doesn’t stop me doing all other things i like doing.

        So is it safe-ish, to tattoo while on Ocrelizumab?

  • Any thoughts on using standard covid19 antibody tests to check vaccine response for anti cd20 treated patients?

    (outside UK so presumably the blood spot test is out)

    • We know the blood spot works where ever to are, once it is dry it is stable and can travel safely in post, sending East coast to West coast of USA same as travelling across the pond. But standard COVID tests work. So work on blood spots but with a typical blood test there is not issue

      The Israeli data used the Euroimmune anti-Spike ELISA. There are a number that are FDA approved. Receptor binding domain (RBD) od spike is most informative, Spike chance of seening response more thanwith RBD and nucleocapsif useless for most vaccines and all vaccines used in Europe and USA at the moment I would stay clear of the Roche automatic tests. There are semi quantitative because they use a capture and different detect agent, so you need both present to get a positive, therefore two thirds of IgG antibodies go undetected. They also detect IgM and IgA so on IgA molecule can give 1-3 signals and IgM can give 1-9 signals

      • So far I read that the bloodspot study was limited to UK residents. I can understand that given the red tape around it…

        Will look into the types of tests available locally.

  • Mousedoctor 1 and 2,

    Best band/recording artist of all time?

    Happy to accept a top 3 if you find it hard to commit.

    • It depends on what you like….MD2 more ecclectic.

      My band in youth was Rush….Born again Maiden…Floyd but look at UFO in their hayday fantasitic live but their recording production quality was terrible…many of early Lizzy albums lacked any umph…Muse were excellent live, what do I have in my car at the moment Josephine and the Artisans (Hip Opera)

      Whats yours

      • Hendrix for me. The live stuff is a bit hit and miss, but the studio records and some of the recordings that didn’t get released when he was alive are incredible. Joni Mitchell, radiohead, the list is endless.

        My wife’s folks were friends with gentle giant, so I’ve had the full prog education. A farewell to Kings was my favourite.

        And they introduced me to the Irish skid row, featuring a teenage Gary Moore. I think they turned into thin lizzy.

        Thanks for all the work you all do.

        • Gentle Giant…never heard of them until I had a Canadian Girfriend (Octupus was the albumn)….abit Jethro Tull (Canadian Girlfriend used to play the flute)…who I never thought alot about…went to see them recently with a few mates, we normally miss the support…turned up at 8.45 ready for the set, turns out it was 3/4 done they were tucked up in bed by 9.30:-( (Very Rock…Not!). First saw Gary Moore Thin Lizzy Bridlington 1979 Black Rose tour

          • I knew you’d be one of the cool kids.

            I forgot Jeff Buckley. The album Grace is beautiful. Perfect to relax to after an evening of writing about brains and stuff.

          • A talent that was sadly taken away from us…one of Ms Mouses favourite albumns

    • Definitely not. I had a minor head injury and was unconscious for anything between 5 and 15 minutes with some minor post-concussion amnesia. Now suffering from post-concussion memory problems, difficulty concentrating, fatigue, insomnia, mood problems (irritability, rumination), flashbacks, etc. This is all resulting in extremely low productivity levels, both physical and mental, and poor academic performance. But I am doing something about it; I am trying not to work as hard (resigned from many activities), I try to go to sleep early at night, more aerobic exercise (difficult because I can’t run), intermittent fasting or ketosis, mindfulness, reading & listening to books for pleasure, and outside interests 😉

        • ‘Without music, life would be a mistake.’

          Friedrich Nietzsche
          19th Century German Philosopher

      • Curious? Prof G was the accident concussion #1 for you?

        I have had 3 serious concussions, plus several good ole American Football head knocks prior to 15 y/o, then I chose only Basketball > 15 y/o. My First concussion was at 8 y/o riding a bike head on into car in 1976, lucky to be alive, I was knocked out for up to 1 hour, I woke up with my Dr stitching up my forehead. MS attacked me at 43 y/o, adds to my future Hell. I am 53 y/o (my mother and brother afflicted by MS as well, both were concussion free). I believe my concussions plus MS obviously has set me up for more brain issues down the road or now vs a typical MS patient, I hope not, but theory is playing out. Many believe I am fine, but does anyone really know your own reality, without being honest to themselves/others. I notice poor sleep duration affects my memory more than anything if I don’t reach 6 to 8 hours daily, the memory deficits are elevated.

        Hope you rebound Prof G, Glad you are listening to your body/brain, sucks to come to grips with your new found limitations, very difficult to admit & honorable admitting your new limitations, taking a few steps back will pay off with less Stress, only one person is gonna back you up, YOU. Hopefully your brain will heal, however age may be in play, probably the older the patient when brain concussed may increase potential brain functions problems. I have had memory issues, headaches, and word finding issues since 8 y/o. I never mentioned to anyone, but when MS attacked I couldn’t fight the issues anymore due to increase in issues mentioned, I stopped working at age 50 y/o. I knew I couldn’t be as safe as the past, one mistake away from a lifetime of regrets. Good luck Prof G I hope your brain heals, get, ok to be selfish, worry about yourself, you deserve the lower work load.

      • Glad to hear you are taking and making time to heal. Post concussion healing takes time and everything you are experiencing, as you know, is real and frustrating….it will change and slowly slowly things will morph to more & more good days. Your plan sounds solid…. good sign that you can read and listen to books! You’ve got this!!

  • ‘Without music, life would be a mistake.’

    Friedrich Nietzsche
    19th Century German Philosopher

    • Because you are asking a clinical question and you need ProfG to anwer these and he doesnt answer every question…I am not qualified to answer these

  • This is a question to MD and its not MS related. What are the challenges that are stopping us from tackling autoimmunity since in most cases the culprit/autoantibody is known? Heard a lot about stopping auto reactive T-cell in EAE but what about actual applications for the many autoantibodies around?

    • Tackling autoimmunity…most immunologists live in T cell land and do not give a second thought about antibodies

      In terms of knowing autoiantibodies in MS, I dont know what they are,

      NMO not enough people and reward.

      Controlling Autoimmunity to antibodies?

      Read “Antigen-specific tolerization in human autoimmunity: Inhibition of interferon-beta1a anti-drug antibodies in multiple sclerosis. Monica Marta, David Baker, Paul Creeke, Gareth Pryce, Sharmilee Gnanapavan, Gavin Giovannoni
      medRxiv 2021.01.24.21250414; doi: https://doi.org/10.1101/2021.01.24.21250414

      Journals not interested

      Hours in day…

  • I’ve had cognitive changes over the last year (at least), could this be caused by smoldering MS? I’ve never had a relapse and been on tecfidera since diagnosed in 2014. Because of my cognitive changes I’m working on switching to ocrevus after I get covid vaccine shot 2. (I have neuro-psych testing scheduled.) Will the ocrevus possibly be better?

    • It’s subjective but I think Ocrevus had some positive effects on cognition for me. Or rather, I feel like the ratio between ok and bad days (with brainfog, mild headaches etc.) became better, bad days still exist though. A lot of confounding factors as soon thereafter we were blessed with Covid…

  • Who will fund the incoming bigger famciclovir trial once you get your results for the first trial ?

    • Shame it didn’t come out yesterday as it would be my April fools.. Luckily they have done some safety studies.
      https://www.futuremedicine.com/doi/full/10.2217/imt-2016-0049?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org3

      The CD3 antibody has been engineered to not cross link which would have meant dead fingers and toes like the elephant head.

      This agent has been given in different ways….orally and now nasally…I wonder what is their reason…to get it in the blood or to track back up the nose into the brain (I dont think so).

      Now to offer some concern “positive immune effects that were most prominent in the 50 µg cohort with minimal immunomodulatory effects at the 10 µg and 250 µg doses, so weird Bell shapped curve…so what happens in a small women and a huge man…Mechanism of action is induction of Tregs (Yawn). This sounds like standard immunology mechanism.

      T cell therapy….bring it on….Will it work and I eat my B cell hat or is it another nail in the T cell coffin. Bring it on…..Concern this agent has been tried in a number of immune conditions.

      Next trying this approach is secondary progressive…..Dizzy Rascal….They are giving themselves the most difficult task

      “Phase 2a trials will be initiated in Q4 2020 for the treatment of MS”…Best of Luck to Harvard with this one..

  • I got 1st AstraZeneca vaccine, had hellish night afterwards with chills, spasms, immobility. But next day right as rain. Just to suggest folk with MS disability are not alone after vaccine.

    • Sounds like Uthoff’s but many people have some level of adverse events….maybe because I’m an old fart….I have dodged that one

      • Glad you’ve been spared! Yes, Uhthoff’s is an old friend of mine right enough.

        Any information on whether 2nd dose of AstraZeneca is better or worse?

        Always going to be better than Covid, I know.

        • With Pfizer second is worse….but for Zeneca it is a hard one…In the trial data the second one is much better which may be good news…but the data was only based on a very small sample size… So please let us know how you got on and as you say better than getting COVID

  • Will the biocard (Biodiagnostics) test tell me if I am immune post vaccine? It supposedly measures the spike protein antibody. I have sent it off this week (£35) so if it comes back positive I’ll let you know (anti CD20 with treatment ‘holiday’ to allow vaccine window so 9 months post dose)

    If you were an NHS worker on ocrelizumab would you change DMT considering the vaccine response is poor and covid isn’t going anywhere (and I want to keep working)….

    • Perhaps…It is an spike Ig test with a yes no answer, so if you were negative before and positive after it is an indication have changed. Howevever it is spike and not receptor binding domain so it doesnt give indication of neutralizing response. It also doesn’t tell you how much you have. However this is true of some other assays, but so do other assays. I gave a rubbish response on dose one, I will take blood post dose two in two weeks. The key is what it is like post dose 2. You should be max by 2 weeks we are measuring 4-6 weeks.

      Remember you can get a blood spot mscovid19Ab@qmul.ac.uk But let us hope you are positive….data from rituximab with other vaccines suggest 6-12 months there may be some blunting still but people like you could be key.

      For those of you who have sent a spot, we will be doing these after Easter. Priority has been ocrelizumab we have over 50 cards back when I checked a couple of weeks ago. Why havent we started we have been waiting for enough to come back so we get answer within a week, so we are not doing lots of assays

      We are not measuring T cells but this is being done, but I think we will see T cell responses this may be enough.

      As for changing I cant make that call, but at present there is not evidence that you are not protected even if there is a blunted response. I suspect you will not be on this treatment for every as there will be increased risk from being hypogammaglubuliemic

      • Thanks for the comprehensive reply!

        I have sent a blood spot a good few weeks ago but it was my understanding that I wouldn’t get a personal result from that, which is why I paid for the biocard one to see my own levels. Is that right?

        • I am not sure what the plan is Dr Ruth can comment, she has been dealing with the ethics and the amendments. Personally I would want to know for NDG ethics, which I was involved with which deals with scientists dentitists and health care workers blood and blood spot in the ethcis we were told to give the results to people in the study.

  • If this truly was not an april-fools joke, I must say Prof G’s possible retirement makes me sad. Since diagnosed three years ago at 23, following research and recently also reading the blog has been an important part of how I cope with the realities of my disease. Discovering that there are really open-minded clinically practising and researching neurologists like Prof G (and also the rest of the team!) that dare challenge established presumptions about the disease has also given me hope – more than anything for those they treat and the next generation of people that will be diagnosed with the disease.
    However i must also say that I believe that us with impacted with MS truly understand why these adjustments may have to be made. Regardless of Prof Gs desicion, i hope to see him still posting on the blog. Feel better!

    • There was no April fools joke…you heard this on the Blog a couple of weeks ago…maybe ProfG thought that March 14 was April 1.

  • What’s the deal with leg pain? The consequences of leg pain are immeasurable.

    While my leg has been giving me off and on extreme pain in the outer calf for the past two+ years, I have been paying close attention. I have been trying to identify the factors contributing to pain or reduced pain – no pain. But one major unrelated conclusion I have made, is that in the world of MS, leg pain is not given nearly the attention it deserves. The consequences of leg pain can begin a tragic decline in physical activity with all the associated aspects, including stereotypes of “what one does”. That includes all the stereotypes also, put upon one who is “not as active as they should be”.
    Some of my experience in this sense includes a general reluctance of neurologists to find the issue of leg pain worthy of close examination and treatment. It seems it is “not in their job description”. Instead, referrals are made to leg and foot specialists. They in turn, really don’t know how to deal with pwMS (I have found) because they just don’t know or understand it- the “whole MS mess”. Instead, they either come from a standard opinion of “no pain no gain”, or a more dreaded opinion that there is nothing they can do for you as the pain is neurological (whatever that means). Perhaps a quick prescription of an ineffective medication is given, further reinforcing the conclusion that nothing can be done.
    I make some other observations: Structural pain versus cramp pain. Inflamed muscles, tendons. When does pain occur? Is the location constant or changing? Pain following activity or pain that wants to be there. Structural changes resulting from walking differently due to MS. Structural inefficiencies present at birth. Too much ice cream- really? Can’t we look to find out the actual physiological origin of an individual’s pain, rather than say “it’s MS”; and treat that without automatically saying, for example, “Do stretching exercises”? (on top of inflamed tendons) On and on….
    I observe that leg pain is inadequately researched for pwMS. It is so, so, significant because of the consequences. The consequences are immeasurable. Maybe they are the most important consequence of having MS, and therefore, shouldn’t more attention be paid? Once you stop walking, ____________. (fill in the blank)

    So my question of the month is “What is the deal with leg pain?

  • Sorry to ask a question you’ve already answered, but I am still a bit confused. Just got my second Pfizer jab this week and definitely had the 24-hour fever/aches/headache side effects. I’m in the US and on Ocrevus, and I want to test for seroconversion. FDA has granted EUA to so many tests, and I am trying to figure out which ones are worth trying. Would you choose RBD over spike generally? IgG over IgM? Do all of the semi-quants (Quest, Abbott) have sensitivity issues or just the Roche one? Also, is 2-6 weeks after the second jab the best window for testing? I did email to ask if non-UK folks can participate in your blood spots 🙂

    Thanks!

    • Spike will give you greater chance of showing a response, RBD it closer to a neutralizing antibody response but will be of a lower magnitude as it is only part of Spikw. I would definately do IgG because this is where the recall response will be. IgM and IgG is OK. They can all detect a vaccine response I am sure. I would do 2-4 weeks (one shot probably 4 weeks). In other studies the maximal response after two doses is there after 1 week.

      Technically there is no reason why a blood spot could not be sent across borderes, but I am sure unless it is approrpiately a marked etc, it will contraveine some rules. DrRuth sends out return labels I believe

    • Publishing is a business and stupid academics have created this problem for themselves and in doing so throw millions of dollars away. Elife set themselves up to challenge Nature/Science using Wellcome Trust funding…did it? Not really, it is just another clique and one more open-access journal that is going to cost you $3,000 to publish. It is about the money. I was recently asked to edit a Frontiers journal and said I would do it if there were no fees involved…The journal sent some wiggly response where it was we have set up an agreement with your University so they pay the fees….This did not mean the University paid the fees, but it made it sound like it did, you could ask for a waiver if you had already done the work. However it is just a scam so you use per pressure on your mates to publish together…They used this approach in the First World War..they were called Pals Regiments the idea didn’t last too long as they them realised that the whole town was killled on the same day.

      We have preprint sites, they are springing up at a rate of knots, it makes it impossible to keep up with as they are scattered everywhere, they have started to close them off eg. SSRN no means you have to become a member fo their club and sign up, next thing there will be a charge to access or deposit. BioRXiv/MedRXiv are toying with the idea of having their own fee paying journal, the NIH goes from deposit straight to pubmed..great idea but then they throw US taxpayers money away on open access/publication fees….They NIH should set itself as a core funded journal and stop this waste of money. Charities say we want our funded papers open acess but doesn’t pay for them. However the money has to come from somewhere.

  • Happy Easter!
    Do you think that people on long term Anti-CD20 may or will lose their OCB? If blood IgG level decreases for long term Anti-CD20ers one could expect the same to occur also in CNS.

    • The antibodies in CNS are probably generated in CNS so the hypogammaglobulinaemia is a separate issue probably

      • Can’t find the source anymore but I remember reading somewhere (or was in my imagination…) a proportion (~50% or greater) of patients lose OCBs after 2 years of treatment. But is there a significants for the patents to lose the OCB?

  • Very interesting article: https://multiplesclerosisnewstoday.com/news-posts/2021/03/17/impact-of-previous-disease-modifying-treatment-on-effectiveness-and-safety-outcomes-among-patients-with-multiple-sclerosis-treated-with-alemtuzumab/

    The insights gained from these types of studies are very helpful. I wish there were more studies looking into the risk/rewards of switching therapies.

    However, I am not surprised by the results of this study, since MD recently posted about a similar case, but instead of Alem failure after fingolimod it was Clad: https://multiple-sclerosis-research.org/2021/01/cladribine-switch/

      • MD – i recall a post (or maybe a comment) from Prog G about the complexities of switching DMTs and that the shift from Ocrevus to HSCT was considered to be one of the least complicated. I am struggling to find it using the search function. I am not expecting you to look but can you at least confirm that i havent dreamt this please?

        • Local HSCT unit said the same, basically don’t care if B cells are missing, we will nuke them anyhow.

        • I am sorry I am not familiar with the switch literature but with HSCT you get rid of everything and start again so I guess it doesn’t matter that much. I’m not a neuro.

    • I had a Dr., who was frustrated by a particular radiologist’ s habit of qualifying every opinion with an opposite viewpoint… the Dr. Referred to the radiologist as a “greased up weasel on a fence”. Location is important, but the keeness of the radiologist is too.

  • Just want to say MD I always appreciate your posts on BartsMS Blog. Thank you for doing these Monthly Q&A’s.

    • Anonymous – I agree, MD is the best!! The blog and greater MS community cannot afford less Prof. G and no MD. 2021 is turning out to be a horrible year so far. I am not sure who got their feelings hurt, but please do not cancel MD1!!

  • BRING BACK MD!

    May those of us who access the Blog, benefit from it significantly and view MD posts as a vital component of this, ask that any offence he has inadvertently given is put behind you (all)(whoever you may be) and please allow him to get back to providing one of his valuable contributions to the MS community.

    Thank you.

  • Mouse Doctor where are you…….Mouse Doctor…………this publication requires your expert assessment and opinion. This is the first published paper I could find where suggestions for switching to cladribine from other DMTs are provided (table 2). However, my question for you Mouse Doctor is….can I trust a paper funded by the drug manufacture? Is their data supported? Are their recommendations unbias? Remember Mouse Doctor, you promised me a post on the topic of switching to cladribine. PLEASE COME BACK!!!!!!!!

    published 2020 Feb 13…….Cladribine Tablets and Relapsing–Remitting Multiple Sclerosis: A Pragmatic, Narrative Review of What Physicians Need to Know doi: 10.1007/s40120-020-00177-5

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7229040/#CR26

  • What test should I use for antibody Pfizer testing?
    Is there / are there any reliable on the market?

    Thanks & Regards
    Rogier

    • Yu want something that detects anti-Spike or anti receptor binding domain, as you appear to be taking ocrelizumab, I am afraind to say if you had vaccine less than 5-6 months after vaccination the chances of responding antibody wise are pretty low. i know you can gt T cell tests in US not sure if there are european options

  • I have been without DMT for 9 months now, after 5 years of DMF (and chronic grade 2 lymphopenia).
    I’m planning on starting Aubagio (not because of new symptoms or new lesions, just not comfortable going without meds). ALC is finally up to 1 again. In my country, I will be able to get the vaccine in a couple of weeks. I’m NOT asking for specific advice on what to do, but am I correct in assuming that starting Aubagio right before having the vaccine will probably blunt my vaccine response?

  • Given there is a generic version of Adalimumab and is much cheaper. Is there any evidence it works for MS?

  • If a pwMS develops lymphopenia on DMF, does he have an above average risk of developing lymphopenia on teriflunomide? (assuming a wash-out periode is respected so that ALC is above 1 before starting the new DMT). Or maybe more generally: does lymphopenia on a particular DMT have any predictive value as to the chance of developing lymphopenia on other DMTs? Or is it really a trial-and-error game for each individual (given the different mechanisms of various DMTs)?

      • Thanks for pointing out drug Luis. Would the the 4 pharmecutical companies have tried to block patent if it was a new treatment step to stop cancer, rather than MS? Same upregulator isn’t it? The pharmecutical companies that blocked patent for use with MS had something to lose. So frustrating when the arbitrariness of what DMDs make it through is highlighted. Rixitaub anyone???

    • The anti-IL17 phase 2 trials in MS were borderline positive. Novartis and UCB did not take their programmes forward because of the moderate impact of their agents in MS.

    • Thanks in the MED EXP article it says “The B cells that most strongly bound to and neutralized the virus belonged to cell populations called memory B cells and activated B cells. These B cells produced mostly antibodies known as immunoglobulin G (IgG) rather than other immunoglobulin types”….This would be true for every ting, but what they did was go fishing with a SARS-COV-2 bait and fished out SARS-COV-2 specific B cells and then sequenced their antibody genes, then made the antibodies and then showed that some clamp the SARS-COV-2 shut to prevent it opening which it needs to do to infect cells. They have a new therapeutic which they could give as a treatment. Very interesting, we should do this to find the antidrug antibodies in MS. You could use the approach to find out what every B cell in the CSF reacts to. They should do this for T cells too…I’m sure it will be done.

      However it will be interesting to see how this is developed. Making anti-SARS-CoV-2 antibdoies as therapeutics has been a fertileground for failure and only recently one had its Emergency use authorization revoked because it didn’t work. These antibodies have largely failed in clinical trials in hospilatised people…I think because it is too late y then. Some antibodies are still approved for administration shortly after infection. However the real use for these I think would be as agents to prevent/limit infection. These trials are ongoing, so is called STORMCHASER where you give antibody to stop infection. They could protect health care workers, but importantly they couldprotect people who cant make a vaccine response because of their disease and/or treatment. The makers of S1P1 and anti-CD20 (which blunt COVID-19 vaccine) should do a study

    • This is absolutely something I would have commented on in the past as it was in the newspapers this week…but is now something I will not do as I have decided that I am no longer going to comment on some types of studies, mechansism of the month and other things whilst on “double secret probabtion” So Sorry to the authors, they can get their altmetrics elsewhere. This is really ProfKs domain and maybe the authors want to come on the blog and do a guest post and explain this work and its significance.

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