CategoryLab Lessons

Protecting nerves with the -imods. Is there something missing

Fingolimod is a sphingosine-1-phophaste receptor (S1PR) modulator. There are five S1PR. The immune modulating effect is mediated by S1P1R. Siponimod is an S1P1R and S1P5R selective modulator. Fingo also binds to S1P3R (this causes some of the heart related issues) and S1P4R in addition to S1P1R and S1P5R. S1P5R is found on glial cells and it has been suggested that repair and protection can occur...

Participating in Oratorio-Hand?

At the recent ORATORIO-HAND investigators’ meetings in Barcelona and Athens, several investigators’ made the point that it may be hard to retain people with PPMS in this trial because ocrelizumab has already been licensed to treat MS. I said YES and NO.  For one a lot of neurologists, HCPs and payers don’t think the original ORATORIO trial was positive. They think the trial was driven by the 25%...

B cells and MS…”It’s behind you”…Are we looking in the wrong place?

As the countdown to B cell week at Charcot Meeting (a meeting aiming at training young neurologists) occurs, I had a gripe that I had been given a miss as far as this meeting is concerned. I will be sat at home licking my wounds, as young new minds are manipulated and learn all things MS. However, what you learn depends on what you get taught. There are a series of company sponsored symposia at...

The Time-to-Think DMT

At an MS Masters Forum in Rome yesterday I was teaching MSologists and MS clinical nurse specialists using a recently created board game, which I like to think of as being MS Monopoly. MS monopoly is based on a game of chance that lets you discuss case scenarios and make treatment choices. Then you roll a dice, which determines the outcome of your choice.  Two things emerge from playing the game...

Rituximab combination therapy

A dark age is when society regresses; it goes backwards in time. The shocking revelations in last week’s New England of Journal of Medicine on the dire situation of some type 1 diabetics upset me and indicates we may be entering a dark age. An age when we are forcing our patients to turn their backs on innovation because they, or society, can’t afford to purchase the necessary medications...

New EAE Model

For the rodent readers, this is one for you. So those who can’t give a stuff about our furry friends, this is not the post for you. We are always on the look-out for models of MS. In this study they look at the myelin oligodendrocyte glycoprotein T cell receptor transgenic mice where all of its T cells react to this myelin protein. This can get EAE, but generatlly they get apparently sub...

Azathioprine revisited

Has azathioprine been given a fair chance as a treatment for MS?  I have noticed over the years that most neurologists, including myself, don’t always use azathioprine correctly. In general, we under-dose azathioprine. Why?  As an example, one of my patients with myasthenia gravis, an autoimmune disease of the nerve-muscle junction, came in this week with a relapse. He weighs 107kg and was on...

Class Action…..Is CD20 depletion an IRT?

Recently ProfG has been talking about immune reconsitution therapies and it has been asked if ocrelizumab is an IRT? This is important to know because it says that you would not have to dose as frequently and whilst this may make a dint in the coffers of the manufacturer, it could mean an improvement in the risk:benefit profile for you…..if this is true. No one wants an EMA or FDA...

Are IRTs ahead of their time?

I am beginning to think that immune reconstitution therapies or IRTs are ahead of their time. Many neurologists, people with MS (pwMS), payers – particularly fee-for-service insurance companies – and the regulators are unable to get their heads around how these agents work. In addition, a few recent review articles, written by colleagues, cast doubt on this treatment strategy and the...

ProfK goes fishing. Blood cells tell you nothing about alemtuzumab…especially if you look in the wrong way!

ProfK has many talents, but I bet you didn’t know he is a keen angler. Now, you won’t find him in Clarme Common with his tackle out at the fish pond…which is a good thing as there are laws against that sort of behaviour :-), but as a card-carrying veggie, you wouldn’t have thought that he likes to fish…… for mice. But that is just what has happened. The new...

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