CategorySymptoms and treatments

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...

Reporting of side effects in RRMS trials

Most research is about investigating the known unknowns. In other words, investigators have a certain hypothesis, but also a range of plausable possibilities as outcomes. However, in some instances the outcome is unexpected – the unknown unknown. Rare side effects are an example of this, and not always evident in the initial randomized-placebo (dummy treatment) controlled clinical trials...

Targeting B cells

Yesterday ProfG posted on off-label agents. This is topical as it is at the forefront of many peoples minds and they are the basis for a number of clininal trials that are planned or on-going Here is a new review to read if interested. It looks at agents that may be used to target B cells within the plasma cells Click here a free read for 50 days Plasma cell and B cell-targeted treatments for use...

Classification of progressive MS

Typically the onset of disease progression in MS is ‘silent’ and differs from person to person. Not surprisingly, attempts at defining at least clinically has not been an exact science. In a letter to Annals of Neurology Gil-Perotin et al. (Valencia) ask an important question, whether progression during the relapsing phase of MS is the same as in secondary progression (refer to MS...

Two strikes your out….Prozac doesn’t make the cut in Progressive MS…Again

Fluoxetine in progressive multiple sclerosis: The FLUOX-PMS trial. Cambron M, Mostert J, D’Hooghe M, Nagels G, Willekens B, Debruyne J, Algoed L, Verhagen W, Hupperts R, Heersema D, De Keyser J; FLUOX-PMS Study Group. Mult Scler. 2019 Jun 20:1352458519843051.  BACKGROUND: Preclinical studies suggest that fluoxetine has neuroprotective properties that might reduce axonal...

Is fingolimod safe in pregnancy?

Safety of Disease Modifying Treatments (DMTs) whilst pregnant and breastfeeding (from Practical Neurology journal) The risk-mitigation strategies surrounding DMTs in pregnancy haven’t come that far over the last two decades. So far, we have abstain from pregnancy, stop treatment prior to pregnancy, stop if you discover that you’re pregnant, or switch to Copaxone during pregnancy...

Filgrastim for natalizumab-induced PML

PML, JCV infection Natalizumab (aka Tysabri), is one of the hard hitters in the DMT world and owing to its mechanism of blocking the ingress of immune cells into the brain, works quickly – achieving control in as little as 4 weeks. In the AFFIRM study, natalizumab reduced the rate of clinical relapse by 68% in the first year! But, one of the drawbacks of stopping the immune surveillance of...

HSV-2 encephalitis with Ocrelizumab

The effect of DMTs on lymphocytes causing lymphopenia (from E Fox et al. Neuol Clin Pract Feb 2019) Why does this not come as a surprise to all and sundry, the report of a potentially harmful infection following immunosuppressive treatment, but this time from the new kid on the block, ocrelizumab (Ocrevus). Not to sound cliched, but if you hadn’t seen this one coming, well then the rest is...

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