CategoryLab Lessons

The Match

No I am not talking about football. There is a lot of talk about whether smouldering lesions are something different, where their origins may be something other than immune attack. Whilst I have no problem with this, based on histology by the pathologists they accumulate over time. Smouldering lesions are lesions with microglial edge There are more smouldering lesions evident in progression Now...

Can rheumatologists stop causing demyelinating disease?

Hello, I am Charalambos Hadjicharalambous, a medical student at Barts and the London School of Medicine and Dentistry working with Dr Gnanapavan (aka NDG) and Prof Baker (aka Mouse Doctor). In my spare time during the COVID-19 pandemic, I have been helping the BartsMS team with their COVID-19 studies. I am writing here to discuss an article that we’ve written detailing a potential rare link...

Purple haze

Barts-MS rose-tinted-odometer: ★★ (Purple Haze Friday #7D7098; looking forward to the weekend) It is quite amazing how large and extensive the focal inflammatory lesion blindspot or scotoma is in the field of MS. I was on a call with a few American neurologists last week and they were saying how anti-CD20 therapy has transformed their MS practice. One neurologist claimed that 4 out of 5 of their...

The big-D (DMTs) instead of the big-C.

First the symptoms, then the diagnosis, then the therapy discussion. Clinicians and patients with MS are constantly facing dilemmas and challenges with a dose of fear. Common questions that concern the DMTs are: Could these drugs be as harmful as efficient? Given that these drugs affect the immune system in various ways, could severe adverse events such as cancer occur? Our recent analysis...

Teriflunomide as a neuroprotective

I do not normally post on the lower efficacy (on relapses) treatments, but teriflunomide seemed to outperform its effect on relapse rate when it comes to saving nerves. This week we had the Mr-CD20 (Prof Piehl) from Sweden come and give us a lab talk about yep you guessed it, anti-CD20. It is always a breathe of fresh air to hear the Swedish Neuros. They are very collaborative and just get on and...

How many ofatumumab doses should I miss?

Barts-MS rose-tinted-odometer: ★★★ (It feels like a sky blue rainy Friday =  #87ceeb) “Prof G how many of my monthly ofatumumab injections should I miss to guarantee that I will have an adequate antibody response to the COVID-19 vaccine?” This was the gist of one of the direct messages I received on Twitter from a person with MS living in the US.  I really don’t know...

Do you want to be treated with low-dose anti-CD20 therapy?

Barts-MS rose-tinted-odometer: ★★★★★ (rose-red; a climbing rose with thorns) I have moved my treatment goal beyond NEIDA (no evident inflammatory disease activity) for my patients with MS. The new focus is on preventing end-organ damage. To achieve this we need to take off the blinkers that the Pharma industry has blinded us with. Our treatment target has to be smouldering MS, i.e. stopping...

Fingolimod vs. Siponimod

Barts-MS rose-tinted-odometer: ★★ (mid-week sepia = #704214) In my post on rebound disease activity in a person with secondary progressive MS switching from fingolimod to siponimod, someone asked whether there is any logic in switching DMTs within the class of S1P modulators. Two or three years ago I would have said no, but now I would say yes. There are well defined and clear differences between...

Zoster

Barts-MS rose-tinted-odometer: ★ (Bank Holiday Monday morning  blues) The next marketing battle in terms of MS DMTs will be herpes zoster and how we manage it. Shingles is quite common in the general population, but it is much more common in pwMS. Why? Probably because of the immunosuppression associated with MS DMTs and the use of high-dose steroids to treat relapses and prevent infusion...

Be careful when switching from Fingolimod to Siponimod

Barts-MS rose-tinted-odometer: zero-★s (purple Sunday) The following case suggests a horizontal switch from fingolimod to siponimod may not be the wisest thing to do. This patient developed severe fingolimod rebound despite switching to siponimod without a washout. As you know fingolimod works on 4 out of 5 of S1P receptors (S1P1, 3, 4, and 5). In comparison, siponimod works on S1P1 and S1P5 only...

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