ArchiveMay 2021

Zoster

Barts-MS rose-tinted-odometer: ★ (Bank Holiday Monday morning  blues) The next marketing battle in terms of MS DMTs will be herpes zoster and how we manage it. Shingles is quite common in the general population, but it is much more common in pwMS. Why? Probably because of the immunosuppression associated with MS DMTs and the use of high-dose steroids to treat relapses and prevent infusion...

Be careful when switching from Fingolimod to Siponimod

Barts-MS rose-tinted-odometer: zero-★s (purple Sunday) The following case suggests a horizontal switch from fingolimod to siponimod may not be the wisest thing to do. This patient developed severe fingolimod rebound despite switching to siponimod without a washout. As you know fingolimod works on 4 out of 5 of S1P receptors (S1P1, 3, 4, and 5). In comparison, siponimod works on S1P1 and S1P5 only...

Thank You, Your COVID Vaccine experiences

Experience with the COVID-19 AstraZeneca vaccination in people with multiple sclerosis.Allen-Philbey K, Stennett A, Begum T, Johnson AC, Dobson R, Giovannoni G, Gnanapavan S, Marta M, Smets I, Turner BP, Baker D, Mathews J, Schmierer K.Mult Scler Relat Disord. 2021 May 18;52:103028. doi: 10.1016/j.msard.2021.103028. Online ahead of print. Background: Some people with multiple sclerosis...

NEO-EOD

Barts-MS rose-tinted-odometer: ★ (milk chocolate; bitter-sweet and addictive) I often refer to MS as being a pink-ribbon disease as close to 70% of pwMS are women.  The rising sex ratio from approximately 1:1 at the turn of the last century to almost 3:1 in most high MS incidence countries and to close to 5:1 in some areas of the world where the MS epidemic is still raging, justifies the pink...

Saturday COVID Lunch

T cells responses in B cell response immunocompromised people This is not MS but I think it is telling us what is going to happen as I am seeing this over and over again. We can predict that people on CD20-depleting antibodies are going to make a poor anybody response, but a greater proportion of people will make a T cell response against the virus. It think the question is how many?. At present...

Disrupt the Status Quo

Barts-MS rose-tinted-odometer: ★★★★★ (seeing turquoise; creative turquoise Friday) She was 42 years of age and had had MS for 16 years. After a relapse in 2016, she was switched from interferon-beta to fingolimod. Despite being NEDA-2 ( no relapses or focal MRI activity) since starting fingolimod her disability has worsened with her EDSS going from 4.5 (walking unaided for more than 300m) to 6.0...

Bladder care is self-care!

Over the past year, I became surprised how many pwMS consider their overactive or neurogenic bladder symptoms as ‘normal’, ‘part of the disease’ or ‘something you have to learn to live with’. I spent many hours explaining pwMS that this is not the case, that these symptoms are, at least partially, treatable, and that treating these symptoms is often more impactful on pwMS’s quality of life in the...

The Fourth eagle has landed

First we had fingolimod, then came siponimod, then oxazinimod and now we have ponesimod after the EMA approved it. These are all Sphingosine-1-phosphateone receptor modulators. Ponvory (ponesimod) is approved for the treatment of adult patients with relapsing multiple sclerosis (RMS) with active disease defined by clinical or imaging features. “Relapsing multiple sclerosis is an unpredictable and...

CURE-3

Barts-MS rose-tinted-odometer: ★★★★★ (still seeing red, despite Summer having finally arrived) I am considering retraining as a medical philosopher. The thinking of the MS research community is riddled with fundamental errors that could be sorted out by applying basic philosophical principles. One example is the diagnostic tautology we are wedded to in how we define MS as a disease. Another...

The causative link of EBV and MS explained?…ProfG will be happy

ProfG has been on an EBV crusade, but why or how does it cause/trigger MS? HLA-DRB1*15:01 is a coreceptor for Epstein-Barr virus, linking genetic and environmental risk factors for multiple sclerosis. Eur J Immunol 2021. The strongest genetic and environmental risk factors for multiple sclerosis (MS), an inflammatory central nervous system disease, are HLA-DRB1*15:01 and Epstein-Barr virus (EBV)...

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