CategoryLab Lessons

How important is your brain volume?

Barts-MS rose-tinted-odometer: ★★★★★ (A blue sky and sunflower yellow Tuesday; #87CEEB #ffda03) I bang on about treating-2-target beyond NEIDA (no evident inflammatory disease activity) and targeting the end-organ, i.e. to try and normalise brain volume loss (BVL). The aim is to get pwMS to old age with a healthy brain so that they can age normally. Who wants to be at risk of premature...

Looking in a crystal ball…Should we supply an anti-COVID-19 antibody response to Immunosuppressed people?

We are reporting frequently on the lack of an antibody response in people treated with anti-CD20 and whilst we think about how we manipulate the biology to encourage B cell responses in B cell depleted individuals, there is another solution and that is to supply people with an antibody response. This can be in the form of convalescent sera (antibodies from people recovered from covid) or SARS-CoV...

Rebranding the MS prodrome: Missed MS?

A prodrome is an early symptom or set of symptoms that indicates the onset of a disease before more diagnostically specific signs develop. One of the most typical examples is a migrainous aura (i.e. flickerings in your visual field) half an hour before you develop a throbbing migrainous headache. However, very often prodromal symptoms are very unspecific. Clouds could be a prodrome of a storm...

Does MS exile you from the everyday of life?

Barts-MS rose-tinted-odometer: ★★★★★ (Sunday or Summer orange #f99f00) Exercise has emerged as a safe, effective, low-cost, non-pharmacological intervention for managing disability experienced by pwMS. Despite the evidence, it is the most under-prescribed and under-utilised disease-modifying therapy we have at our disposal.  Exercise promotes improvements in aerobic capacity, muscular strength...

The art of switching!

Natalizumab blocks the lymphocyte migration over the blood-brain barrier and is one of our more potent disease-modifying therapies (DMT). In the phase 3 trial, it reduced the annual relapse rate with 68% compared to placebo and it is typically given as a first/second line therapy to pwMS tagged with the unenviable label of ‘highly active’ disease. However, this is as far as the fairy tale...

Splosh, Splosh Splosh, the drips are increasing Vaccination and fingolimod and anti CD20 are like oil and water…Not mixing

Today we have the first interim analysis of vaccination data from Italy they have looked at over 700 people on their way to studying 2000 people. So I think we can safely say in terms of anti-CD20 and fingolimod, that they are problem children in terms of the antibody response Effect of SARS-CoV-2 mRNA Vaccination in MS Patients Treated With Disease Modifying Therapies. Sormani et al. Background:...

COVID19..Drip, Drip Drip….B cell repopulation determines the ability to give antibody response after COVID-19 vaccination

Learning from other conditions is useful. As there are more people with rheumatoid arthritis than MS we will see alot of anti-CD20 papers with rituximab. There will be subtle differences compared to ocrelizumab. So when you read the paper that says the vaccine response to anti-CD20 is unknown….it’s not its getting less unknown by the day. If you are taking ocrelizumab you should...

Die Wende: Extending the anti-CD20 overdose

It’s a bittersweet fact that wars spark big leaps in science, and this has unfortunately also been true for our fight against the COVID-19 pandemic. When it comes to treating MS, susceptibility to common infections and ability to mount vaccine responses have become important themes among neurologists. Furthermore, pwMS prefer drugs that do not require regular hospital or phlebotomist visits. One...

CD20 and COVID-19

The CD20 onslaught continues at a pace and there is no refuting it, anti-CD20 depletion blocks the formation of vaccine response. I have seen this occur irrespective of the vaccine that was used. I am sorry to say if you are on anti-CD20 you are going to see this over and over again…it will be like-water torture, drip, drip, drip. Yep and I control the tap (faucet for our American readers:...

Mortality: what risk would you be prepared to take?

Barts-MS rose-tinted-odometer: ZERO-★’S (Black Tuesday – a tear for my beloved country #000000) As you are aware by now I am a proponent of flipping the pyramid and using high-efficacy DMTs first-line including immune-reconstitution therapies (IRTs) such as alemtuzumab and AHSCT. I justify the latter two options based on the fact that given sufficient time the vast majority of pwMS will...

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