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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...

MS susceptibility is it puberty, or is it something else?

The risk of developing MS reportedly increases with early puberty, particularly in women. This leads to interesting hypotheses around the effect of hormones on the maturation of the immune system. But what if there was another equally plausible reason for this finding? For instance, having more body fat at childhood leads to earlier puberty, which in turn is also associated with an increased risk...

April Fool: Prof G to retire August 2019

This post launched on the 1st of April was an April’s fools prank. It is with great sadness that we announce Prof G will be leaving Barts-MS later this year. He is turning 55 this year, the earliest official retirement age if you work in the NHS. ‘Burnt-out at 55‘ is how he describes his life. So he and his wife have decided to decant from London to the South Coast of England...

Maven has Landed on the other side of the pond

Thanks FDA….you made our REF2021 impact statement even better!!!!…… Only joking.. but today signals a new chapter in our journey with cladribine. The MDs became CLAD lads way back in December 2004, when we did our first experiment with cladribine. We saw the potential of the intravenous and subcutaneous variant in MS and had spotted that we could develop an oral variant, if we...

Newsflash new addition for secondary progressive MS

Treatment arrives for secondary progressive MS. Siponimod has been approved by the FDA in the US. This can be used from clinically.isolated syndrome onwards. So why would you want fingolimod? I wonder. They work the same way but siponimod may have lesser side effects. What will NICE do? keep it second.line like fingolimod or.give it a first line licence. I guess it depends on what the EMA say...

DMF versus Teriflunomide

Treatment algorithm (Ingwersen J et al.) Did I hear you say injectables, what injectables? The turf war in the first-line RRMS treatments is clearly between the two oral therapies; dimethyl fumarate (DMF) and teriflunomide (Teri)!Each have their Achilles heel. DMF with its lymphopenia (drop in lymphocyte counts) and Teri with its transaminitis. So, it isn’t surprising that the weighing...

If it looks like a duck , quacks like a duck..its a duck. DMT are worthwhile

Changes in the Risk of Reaching Multiple Sclerosis Disability Milestones In Recent Decades: A Nationwide Population-Based Cohort Study in Sweden.Beiki O, Frumento P, Bottai M, Manouchehrinia A, Hillert J. JAMA Neurol. 2019 Mar 18. doi: 10.1001/jamaneurol.2019.0330. [Epub ahead of print IMPORTANCE:Clinicians’ experience and findings from recent natural history studies suggest that...

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