CategoryAdverse reactions

Thyroid problems post alemtuzumab in MS, the endocrinologists take on this

Thyroid dysfunction is the commonest treatment related side effect after alemtuzumab. Alemtuzumab targets CD52 on the surface of T and B cells taking them out of circulation. The precursor cells to the adult T and B cells are left intact because of their lack of the CD52 surface marker. After cell depletion, which occurs very quickly there is then a period of immune reconstitution resulting in...

Rebound after switching with fingolimod

Rebound in MS disease activity occurs when coming off highly-active drugs. It refers to a return in MS activity that is more than before. The drugs most likely to demonstrate this are the highly-active treatments that are given on a regular basis (i.e. maintenance treatments, such as natalizumab and fingolimod – it is too early to say with ocrelizumab) that create a gating system for the...

Low lymphocyte counts on Tecfidera in MS

The degree of efficacy of MS drugs equates to the degree of immunosuppression. The latter is not the result of anything convoluted, but simply due to a depletion in lymphocyte counts (also called treatment related lymphopenia). Even drugs that proport not to be immunosuppressive (fingolimod and natalizumab) are immunosuppressive, but in a compartmentalized fashion. This explains the risk of...

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...

Translate

Categories

Recent Posts

Recent Comments

Archives