CategoryDMT trials

Inauguration Day

No, not THAT type of inauguration on the US Capitol facing the National Mall, but rather facing an audience in the Blizard Institute’s Perrin Lecture Theatre, colour scheme of which is modelled on a Poppy field, as ‘In Flanders Fields‘, with mostly green and a few dotted red seats. ProfAngray and myself gave our inaugural lectures there last night, in my case this was three...

Ponesimod in RRMS – long-term clinical trials

Ponesimod, like fingolimod and siponimod preceding it block the ability of lymphocytes to leave the lymph nodes, thereby lowering circulating lymphocytes. As such the clinical effect is similar in the broad sense to that of it’s parent compounds – this includes efficacy and side effects. Unlike fingolimod (2nd line for active RRMS in the UK) and siponimod (reserved for active SPMS in...

Who would have guessed but DMDs improve survival

The number of times I’ve been asked whether DMTs have any impact in survival is countless. For those of you who are aware of the effect of MS on survival these study findings will be of great interest to you. It will also hopefully gets people who are still unsure about starting treatment off the fence. In a large review of administrative health databases in Canada amounting to 35,894 MS...

Spot the mistake? A self-fulfilling hypothesis

En face this research seems straightforward, but upon reading the methodology of the manuscript my first thought was ‘huh’? Why the ‘huh’? Well, if you’re going to study on humoral immunity (i.e. antibody formation), the drug not to use is Ocrelizumab or any other anti-CD20 for that matter. The MOA (mode of action) of anti-CD20s is to target B-cell function and...

Does Teriflunomide as a DMT warrant discussion?

Speaking as a clinician who goes by the mantra ‘treat early, treat hard’, platform therapies as a whole receive less attention from me than highly-active treatments. However, I know that they have a place in the MS armamentarium and admittedly, I have a more than few patients on Teriflunomide. Some of whom have been stable on it for many years, whilst others I’ve had to transfer...

Harnessing the pregnancy effect in Multiple Sclerosis

It is now well accepted that MS goes into a period of dormancy during pregnancy. This of course is a protective effect so that the female body doesn’t reject the foetus that is growing within (the foetus is a foreign entity as it’s whole genetic makeup does not come from the mother alone). Increasingly it has become apparent this effect is mediated via the oestrogen hormone, a female...

Mesenchymal stem cells lower neurofilament levels in progressive MS

You would have heard about HSCT for MS, but Mesenchymal stem cells (MSC) are a very different type of treatment and less well known than HSCT. In fact, I would go so far as to say that interest in this therapeutic option is almost non-existent. However, when I came across a recently published biomarker paper on this topic I thought it would be interesting to have another look at it. Further...

4 or 6 week natalizumab dosing

In a attempt to reduce the risk of PML dosing was extended and it was sugggested that you get reduced PML without an influence of disease activity. This study by the manufacturers of a natalizumab variant did a study and concluded that there was not PML risk difference by there were more lesions in the extended dosing group, with the acknowledgment that a few people (n=2), skewed the data alot...

Treatment is beneficial

I guess you know this already….wonder when the HST comment will arrive? Association of No Evidence of Disease Activity With No Long-term Disability Progression in Multiple Sclerosis: A Systematic Review and Meta-analysis.Rotstein D, Solomon JM, Sormani MP, Montalban X, Ye XY, Dababneh D, Muccilli A, Shah P.Neurology. 2022 Apr 26:10.1212/WNL.0000000000200549. Objective: We...

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