CategoryLab Lessons

Teriflunomide’s secrets

Barts-MS rose-tinted-odometer: ★★★★★ What should be our therapeutic target in MS?  Reducing relapses and MRI activity, NEDA (no evident disease activity) or saving the end-organ (brain volume loss)?  I have been pushing the for the latter, i.e. the most important treatment target must be protecting the end-organ and saving or protecting as many neurons, axons and synapses as possible in...

Vaccines and Ocrelizumab (VELOCE): Old swords, new swords, and how to avoid stab wounds!

As approximately 70% of our newly diagnosed people with MS go onto ocrelizumab (a CD20 and thus B cell-depleting monoclonal antibody), a study that helps us understand how ocrelizumab affects the potential to mount (protective) antibody responses to vaccines and new antigens is more than welcome. Especially, as we are all hoping for the COVID-19 vaccine to be under the Christmas tree.  B...

The war on descriptions, should we rage the same war on the the Animal experimentalists

ProfG has been talking about the nomenclature surrounding MS, because it matters in what can be done for people with MS. You may view him like “Atlas” with the Weight of the MS World on his shoulders. However, with all the running he has been doing, he has turned into “Stick-boy” and the weight of MS is crushing him as he gains a few bruises from dealing with the...

Is this the end for animal work on myelinating cells…it should be.

Recently there has been a debate on whether humans myelinate like animals and the suggestion was that in MS they may not. Yet we are ploughing huge resource into animal experiments to find repair agents for humans To work on animals, you typically have to have ethical approval and in Europe you need to consider reduction, refinement and replacement of animals in research. Each year we have to...

Phenytoin in acute optic neuritis

The original phenytoin study, published by the team at University College London, demonstrated that the use of phenytoin (- sodium channel blocker) for three months after the onset of acute optic neuritis was neuroprotective. Slide from Medscape education We have now analysed the blood samples taken for neurofilament analysis and found that neurofilament heavy chain levels (as opposed to light...

T time…Is it time for Otilimab/ mavrilimumab?

Otilimab and mavrilimumab are human antibodies that block Granulocyte-macrophage colony stimulating factor (GM-CSF) of the GM-CSF receptor respectively. The may block macrophage function but could also block a new T cell type implicated in MS, which secretes GM-CSF J. Rasouli et al. A distinct GM-CSF+ T helper cell subset requires T-bet to adopt a TH1 phenotype and promote neuroinflammation...

Progressive multiple sclerosis is a misnomer

Barts-MS rose-tinted-odometer: ★ In my opinion, the term ‘progressive multiple sclerosis’ is a misnomer. In general, progression means improvement, which is one of the reasons I prefer the term ‘late-stage MS’, which not only differentiates the terminologies but captures the associated disability that comes with this phase of the disease. It is important to stress that the pathologies that drive...

Swiss Neurologists Challenge Lublin

Barts-MS rose-tinted-odometer: ★ I have just been chastised by someone from a Swiss Pharma company for suggesting that siponimod is a cul-de-sac DMT. Why can’t someone who is diagnosed and labelled as having SPMS who is started on siponimod be switched to any other DMT? I agree, but the absurdity of the situation arises because of the rigidity of the Lublin classification of MS (see below) and...

Anti-CD20 Derisk Study

Barts-MS rose-tinted-odometer: ★★★★★ Did you watch the anti-CD20 debate on the triMS-online platform yesterday? The question that was asked was ‘Can we use anti-CD20 therapies as immune reconstitution therapies rather than maintenance therapies?’. I am not sure the debaters answered the question.  When I asked Anders Svenningsson, who is probably the world’s biggest adopter of anti-CD20 therapy...

Are you a super-responder?

Barts-MS rose-tinted-odometer: ★★ For every DMT there are patients who respond and there are those who don’t respond. Trying to predict who will be a responder and non-responder is not possible upfront. This is why we talk in averages, i.e. what happens to populations of patients and extrapolate backwards to the individual. If only we have individualised or personalised prediction tools. ...

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