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A moan…Doing trials to pat yourselves on the back for a paper and a job well-done is not what it’s about… Changing clinical practise is what it’s all about

A couple of years ago Dr Raj Kappoor and ProfG did a trial in optic neuritis and tested a sodium channel blocker to see if it could save nerves in the eye after optic neuritis. This was based on studies that MD1, 2, 3 & 4 had done in the beasties. The trial worked and it saved loss of nerves by about 30%, but then what?….Yep Nothing. I said to the neuros..”You have done a trial...

Teriflunomide is contraindicated in pregnancy

Abstract BACKGROUND: Teriflunomide is contraindicated in pregnancy. Some pregnancies have occurred despite guidance to use effective contraception. OBJECTIVES:To report outcomes of pregnancies occurring in teriflunomide clinical trials and the post-marketing setting. METHODS: Outcomes are summarized for pregnancies in teriflunomide monotherapy clinical trials and the post-marketing setting (data...

There is a reason why Neuros should not be comedians-Don’t change your appointments

Hello Peeps, for regular blog readers you know that I am the funny one, who can light up your day with a smile and a bit of light relief. For people attending ProfGs clinics who don’t want to read this look at the Red The neuros are the serious ones in grey suits who tell you how it is and dole our the good and bad news and sometimes tell you about their inner sensitive self. I woud say I...

Alemtuzumab use put on Restriction

The European Medicines Agency (EMA) has started a review of alemtuzumab following recet reoports of sde effects affecting the heart, blood vessels, liver and immune system.  These side effects are rare but potentially serious. As a temporary measure while the review is being carried out, the EMA has advised that alemtuzumab should only be started in people with relapsing remitting MS that...

A treatment for PML

It seems this is PML week. first PML on alemtuzumab and now this….a treatment for PML or is that that Two I first thought wow….but then I read the title and I thought that maybe I’m being a bit thick here because I have seen a few people wetting their pants on twitter with excitement on this news, but maybe I am missing something? You have a disease that causes white blood cells...

PML on Alemtuzumab

Immune profiling of a patient with alemtuzumab-associated progressive multifocal leukoencephalopathy. Gerevini S, Capra R, Bertoli D, Sottini A, Imberti L. Mult Scler. 2019 Apr 9:1352458519832259.  A 31-year-old woman affected by multiple sclerosis (MS) experienced generalized tonic-clonic seizures 2 months after the second alemtuzumab cycle. Positive JC virus (JCV)-DNA in cerebrospinal...

B cell antigen making macrophages young and able to repair

CD22 blockade restores homeostatic microglial phagocytosis in ageing brains.Pluvinage JV, Haney MS, Smith BAH, Sun J, Iram T, Bonanno L, Li L, Lee DP, Morgens DW, Yang AC, Shuken SR, Gate D, Scott M, Khatri P, Luo J, Bertozzi CR, Bassik MC, Wyss-Coray T. Nature. 2019 Apr 3. doi: 10.1038/s41586-019-1088-4. [Epub ahead of print. Microglia maintain homeostasis in the central nervous system through...

Just as the Lumpers appear the Splitters reappear…2 diseases or trial design problems-Ibudilast

We have been making the case that MS is one disease, with different pathological features that may need different approaches. Therefore we Lump the different MS subtypes (primary and secondary progressive and relapsing MS together) This contrasts the splitting of MS into differnt MS subtypes. Recently siponimod has been approved for relapsing and secondary progressive MS and so lumped together by...

Is this the cause of MS?

You know me…yep a troublemaker. I am not a hotshot hardcore human immunologists, but I can read, just about, and as you know… I sometimes have opinions and express them. Maybe I do myself no favours. We have had the suggestion that there is an protein that causes immune cells in MS to proliferate and this has then been suggested to be the target in MS. I say lets have a look at the...

What about Atrophy?

ProfG has thrown the T and B curve ball by suggesting that brain atrophy data is better with the T and B depleters (Alemtuzumab and HSCT) than the relative B depleters (Ocrelizumab and cladribine). This is an interesting observation and if correct it needs to be brought into the MS World View. This may point the finger at CD8 T cells as this subset deleted less than CD4 by cladribine and is...

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