CategorySymptoms and treatments

Alemtuzumab and B cells. Snooze and you may lose

About 5 or more years ago Prof G and I went to see Genzyme to propose a study on doing B cell depletion after alemtuzumab to try and limit, ideally prevent, secondary autooimmunity that occurred in about 50% of people with MS who were treated with MS. At the time there was no ocrelizumab, cladribine in the picture and they simply were not interested in B cells. They thought T regs increased after...

Price competition for New drugs doesn’t exisit

I was in the Netherlands at a science meeting (Yep ProfG let’s me out occasionally) and a pharma (marketing) person gave a presentation. They were there for the people with MS and it wasn’t all about the money. Now the Dutch are not known for their tact and tend to say it how it is, from their prospective, and “mushroom food” was uttered. I think Jeffery J in the audience...

Is DMF the new GA?

Glatiramer acetate has had more mechansims than most people have had hot dinners :-), without really asking the question how it works but does it work well enough? However, is dimethyl fumarate DMF moving in the same territory. Dimethyl fumarate was first described to be an anti-oxidant working via Nrf2. Work in Nrf2 knockout questioned this and then we had GPR105 and a CD8 dependent mechanisms...

Measles a known unknown

I was called to casualty to assess one of my patients with MS who was on natalizumab. She had been admitted with a temperature, confusion, seizures and a generalised skin rash. Within thirty minutes of seeing her, she went into status epilepticus and had to be sedated, intubated and admitted to ITU. Within 72 hours she was dead. At post-mortem, she had a measles pan-encephalitis. Four days before...

HSCT in MS, more a remission than a cure

In a prose to seduce the weary palate, the British neurologist, I recollect saying: “What should be the aims of HSCT treatment? At worst, remission. At best, a cure“. I may just have to eat my words… In a small study from Uppsala University (n=45), Larsson et al. report the effects of HSCT on neuronal damage (using neurofilament levels) and inflammation (IgG index and...

Is too much vitaminD bad for you?

I noticed DrK tweeted on this and suggested that I have a look. The implications are that a middling amount is beneficial, but too much vitamin D is bad for you because it affects calcium levels in T cells. This may be lapped-up, because no doctors would think that you should be eating vitamin D capsules like smarties (Sugar coated chocolate sweets). Of course one says No s**t Sherlock, we...

A cost too high? The cost-effective analysis (CEA) of our current DMTs

‘Primum non nocere’ – Do no harm; the Hippocratic injunction. It could be argued that perhaps were are too ready to dose our expectant patients with the next golden ticket in MS. Mayhap, withdrawal of the long list of medications that they are already on, can prove to be just as efficacious? Yet, I am not a great supporter of masterful inactivity on the part of the physician...

I’m on treatment, why am I getting worse

Today someone asked “Selma Blair today tweeted she is getting sicker with her MS. Given her personal wealth and access to the best treatments. And we now have treatments that effectively shutdown ms in rrms. Also given she has had plasma exchange. My question is why is she getting sicker? “ The simple answer is I don’t know because I am not familiar with her particular case...

HSCT, is it remission, or is it a cure for MS?

Most of you who read the blog know that I’m highly cynical when it comes to the word ‘CURE’ in the same sentence as a brain disorder or autoimmunity. In fact, it’s very similar to hearing the word VEGAN in the same sentence as pizza or donuts (apologies to any vegans who are currently sitting across from one of these right now; there’s always tomorrow). Why? Where do...

Bad Drug?…..Bad Idea? Remyelination Trial accepts the Null Hypothesis

The orginal title was changed read the comments Safety and efficacy of opicinumab in patients with relapsing multiple sclerosis (SYNERGY): a randomised, placebo-controlled, phase 2 trial.Cadavid D, Mellion M, Hupperts R, Edwards KR, Calabresi PA, Drulović J, Giovannoni G, Hartung HP, Arnold DL, Fisher E, Rudick R, Mi S, Chai Y, Li J, Zhang Y, Cheng W, Xu L, Zhu B, Green SM, Chang I...

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