CategoryAdverse reactions

A Tale of Two COVIDs – Part 2: When Omicron strikes…

“I couldn’t breathe properly. It felt like this was going to end badly. Frankly I was scared stiff.…” Christine Chapman is a film editor living in London. She is in her mid 60’s has MS, is on Ocrevus and had been triple vaccinated. Before Christmas she caught the Omicron variant of Covid-19 and came very close to paying the highest price. This is her story… “About a week before Christmas, I...

A rare life-threatening adverse event on Copaxone

Odd as it may seem, one of the safest DMTs in the MS world, Glatiramer acetate (Copaxone) can also give some nasty rare side effects. In this unfortunate lady the drug-related side effect involved her breasts (apologies for the pictures if it is distressing to some of our readers). But, in a previous case report a generalized skin vasculitis has also been described (see abstract below). An...

Immunodeficiency after MS treatments, a rising concern

You can read the full text of this review article for free on the internet, but in a nutshell the article is about secondary immunodeficiency after immunosuppressive treatments. Immunoglobulins or antibodies are produced at a basal level in all of us to protect against infections. However, when you are low in antibodies you’re at an increased risk of infections. This ranges from a common...

Subcutaneous Cladribine as a Treatment Option

After Cladribine tablets had been rejected by regulators in 2010/11, Merck-Serono binned their respective development programme. This was in spite of excellent data on disease control and adverse events – if there hadn’t been those three cancers in the active arm of the CLARITY study (and none in the placebo arm). Although it subsequently turned out the malignancy risk with cladribine...

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...

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...

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