CategoryAdverse reactions

A new spin on immune reconstitution

We’ve all heard of alemtuzumab induced thyroid autoimmunity; a side effect affecting roughly 30-48% of individuals receiving the treatment. It is believed to occur when immune cells, particularly autoreactive IgG+ memory B cells return early following depletion of the lymphocytes, leading to a breakdown in the immune tolerance towards the thyroid. But, according to this case report, an...

Infection risk secondary neutropenia with ocrelizumab

All drugs have a range of predictable side effects. In the case of immunosuppressants/immune depleting agents this is a low white cell count, which increases the risk of infection in the short- or long-term. Ocrelizumab is a monoclonal anti-B-cell (anti-CD20) treatment that specifically targets B-cells, but it may also have what we in the business call off target effects on other immune cells...

Ocrelizumab removing infection protection in a small number of people

Alba Suárez EM, Tallón Barranco A, Puertas Muñoz I, Chamorro Hernández B, Robles Marhuenda Á. Non-late-onset neutropaenia following treatment of multiple sclerosis with ocrelizumab. Neurologia. 2021 13:S0213-4853(21)00026-8. Late-onset neutropaenia (loss of neutrophils which are our first line against infection) is defined as an absolute neutrophil count of <1.5×103cells/μL starting>4 weeks...

Anti-CD20 more than just B-cell depletion

Barts-MS rose-tinted-odometer: ★★ (amber; a sleep deprived colour somewhere between yellow and orange) It has become clear that the anti-CD20 therapies are more than just anti-B-cell therapies. Minority populations of both CD4+ and CD8+ T-cells and NK-cells express CD20 and are depleted after both rituximab and ocrelizumab treatment.  It looks as if ocrelizumab may be more effective in...

The take on BTK inhibitors: AAN 2021 has the answers

The scientific sessions at AAN 2021 were pretty devoid of exciting new developments (not surprising given COVID19), but did present updates on the use of BTK (Bruton’s Tyrosine Kinase) inhibitors in multiple sclerosis (MS). For those of you who hearing this term for the first time today, BTK inhibitors target both B cells in the periphery and resident microglia in the brain (see slide...

Stuck in a loop

Starting certain MS drugs may get you stuck in a loop that you never bargained for when you started them in your early thirties or forties. The ability to stop taking drugs at an older age is something we more or less take for granted, especially if we have been disease free for ‘X’ many years. However, in the MS world things are never that simple or straightforward; there is...

The B-cell line up

Figure: Anti-CD20s (A) rituximab (yellow), (B) ocrelizumab (red), (C) ofatumumb (green), (D) ublituximab (brown) The B-cell line up for MS now reads: rituximab, ocrelizumab, ofatumumab, and ublituximab. A fair number of you believe that these four treatments embody some magical powers, but I am about to demystify some of these beliefs and explain the science behind them. The three main take away...

Polypharmacy in MS

In this blog, our overarching goal has been to keep our readers up to date with the latest research in MS. One of the things I’ve noted in this time is that the vast wealth information out there isn’t insurmountable – you only need to select the ones that appeal to you, or are relevant to your practice. Information/’knowledge’ is probably the last bastion of...

Food for thought

The gastrointestinal tract (image taken from The Conversation) You may not think much of your gut, which in most peoples mind is simply one giant hosepipe from start to finish. But, this week after eating something quite oily, I was painfully made aware of my gut’s existence. The gut from an energy and metabolic point of view is a very important organ, and without it you would simply be a...

Translate

Categories

Recent Posts

Recent Comments

Archives