B cell depleting therapies are the safest and most preferred treatment of highly active multiple sclerosis?


This was a debate I fought yesterday in Gods own Country……. and I am still in shock that I lost:-(.

As I pointed out all effective therapies (eg alemtuzumab,caladribine, ocrelizumab, interferons etc.) for MS depleted B cells and stop them entering the CNS and supplied fact. The opposition seems to use the “Chewbacca defence” and cited nothing relevant to the debate but just like Chef defend by Johney Cochrane in South Park..they won:-)

I wonder whether COVID-19 and CD20 sunk me with regard the “SAFEST” if they had used SAFE I may have Won:-

As I was off to the toilet to slash my wrists….an audience member said it was interesting how a scientist and a clinicican approaches the contest. Maybe I did information overload.

Maybe the arguments used were just rubbish

However, next week we may be able to post on how to make CD20 safer during COVID-19 Dr Ruth has submitted the paper if may surface soon.

My opponent used COVID-19, dubious information and some case histories where most people may select natalizumab or cladribine, HSCT as choices…..They would not accept that natalizumab cladribine and HSCT are B cell depleting therapies. In these debates you just have to create some doubt. However it tries to provide balanced information with a YES and NO argument

General Disclaimer: Please note that the opinions expressed here are those of the author and do not necessarily reflect the positions of the Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust and are not meant to be interpreted as personal clinical advice. 

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  • Wait, how does natalizumab deplete B-cells and/or stop them entering the CNS? Anyway, I kind of agree that “selective” B-cell depleters are not the preferred way to manage highly-active MS. Hit it with alemtuzumab or HSCT is my view, and forget about trying to target B-cells in particular. I think Prof G has also speculated that depletion of T-cells in addition to B-cells is part of what gives alemtuzumab superior efficacy.

    • Natalizumab does not deplete B cells physically in the blood but serves to deplete B cells by stopping them entering the CNS. Alemtuzumab is a B cell depleter so is HSCT and you have bought into the idea that alemtuzumab trial data means it it is superior to ocrelizumab trial data. They are not comparable. Do a head to head trial. I am prepared to accept that alemtuzumab is better than ocrelizumab but compare apples with apples

  • “ They would not accept that natalizumab cladribine and HSCT are B cell depleting therapies.”……..what!?! how!?! why!?!

    How can they think cladribine is not B cell depleting? The scientific evidence is clear and well documented. Do they have their head in the sand, or better yet, is their head up their bum (which has been lubed with the tears of the T cell focused neuros that came before them).

    I can send them my most recent lymphocyte subset showing my cd19 B cells dropping from 176 u/l to 5 u/l shortly after completing year 1 of Clad.

    T cell fools! When will they accept the B cell theory.

    • In the debates you are dealing sometimes with the Flat Earth Society. I realise the way to get yourselve believed is that you say it with enough confidence, you can make any old SH1 up. This is what happens at conferences. Most people are not confident enough to say no you are talking mushroom food so they get away with it:-(

  • Mousedoctor, you’re too logical for your own good.. A sound argument is a valid argument with true premises. But To win an argument it’s a bit different; one must convince the audience egos which premises are faulty, which true. Know your audience, exploit the faulty premises, leave audience faced with remaining true premises. (Yes, my husband does not like to argue with me. 😉)

  • Keep on tying to educate them, someday the penny might drop. Don’t give up…..we need your expertise . Your humour is refreshing too..

  • It was a marvellous presentation and in my opinion the only one qualifying for the label ‘ADVANCED MS Masterclass’ .

  • But arnt treatments that also reduce T cells more effective in the long term? Regarding smouldering MS such as current IRTs and natalizumab?

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