When we were children we used to get Dot to Dot books where you would join the dots to make a picture. If you just have dots you don’t really have a clue what it is you are drawing
Add a few lines to give a context and a more complete picture and it is alot easier to see what is going on, when you join the dots.
So ProfK will be getting a book for Christmas so that he learns to tell his friends on the benefits of getting the whole story at once. Because if you have a few lines at the same time you have the dots, it is a lot easier to see what is going on and if you dont get them at the same time you have forgotten all about what went before.
Today we get a book of dots
de Stefano N, Barkhof F, Montalban X, Achiron A, Derfuss T, Chan A, Hodgkinson S, Prat A, Leocani L, Schmierer K, Sellebjerg F, Vermersch P, Wiendl H, Keller B, Roy S; MAGNIFY-MS Study Group. Early Reduction of MRI Activity During 6 Months of Treatment With Cladribine Tablets for Highly Active Relapsing Multiple Sclerosis: MAGNIFY-MS. Neurol Neuroimmunol Neuroinflamm. 2022 Jun 14;9(4):e1187
Background and objectives: This study (MAGNIFY-MS) evaluates the onset of action of cladribine tablets by observing changes in combined unique active (CUA) MRI lesion counts during the first 6 months of treatment in patients with highly active relapsing MS.
Methods: MRI was performed at screening, baseline, and at months 1, 2, 3, and 6 after initiating treatment with cladribine tablets 3.5 mg/kg.
Results: After treatment initiation, significant reductions in mean….lesion counts were observed from month 1 onward compared with the baseline period….all p < 0.0001). Mean T1 Gd+ lesion counts were decreased from month 2 onward compared with baseline
Discussion: Findings suggest an early onset of action for cladribine tablets, with an increasing reduction in active MRI lesions over time.
So join the dots and I think you get: cladribine works within one month of treatment
I suspect we will get another book of dots, which has no lines, but lots of dots. This has already been presented and this is the effect on cladribine on immune cell subsets.
Characterization of Peripheral Immune Cell Dynamics and Repopulation Patterns in the First 12 Months of Cladribine Tablets Treatment: MAGNIFY-MS Study H. Wiendl, K. Schmierer, S. Hodgkinson, T. Derfuss, A. Chan, F. Sellebjerg, A. Achiron, X. Montalban, A. Prat, N. De Stefano, F. Barkhof, L. Leocani, P. Vermersch, A. Chudecka, S. Roy, U. Boschert. ECTRIMS 2021
In that study we will have the effect of cladribine on T cells, CD4 T cells, CD8 T cells, natural killer cells, naive and memory B cells, antibody producing B cells
So this dot-to-dot book will be be a confusing and the story line is everything is in a network, it is all lovely and we have no idea what is going on, so we can do more work on NK cells, Th17, T regs, rather than focus our attention on something important etc.
However, if you join the the dots and you are told where to look and they are all in one place, you may get a story
Disclaimer: This is the view of the author and no one else