CategoryTrials

Mesenchymal stem cells lower neurofilament levels in progressive MS

You would have heard about HSCT for MS, but Mesenchymal stem cells (MSC) are a very different type of treatment and less well known than HSCT. In fact, I would go so far as to say that interest in this therapeutic option is almost non-existent. However, when I came across a recently published biomarker paper on this topic I thought it would be interesting to have another look at it. Further...

Hit and Run or Should I say Hit and Crawl. The speed at which white matter damage leads to grey matter changes

We often hear “I swapped to drug X or Y and I still feel I am getting worse”. This not surprising because it takes time for the attacks to run their course, So in this study they looked to see how quickly damage to the white matter (myelinated axons= nerve body) took to show itself by loss of neurons in the grey matter (nerve heads). Here they imaged people repeatedly and they looked...

AAN2022 Natalizumab and the Me-Too

Natalizumab is being used by ProfK in the AttackMS trial, which is to treat at first sign to prevent subsequent attacks, whilst diagnostic work-up is done and getting people onto highly effective treatment quickly. This is going to use standard monthly intravenous dosing. This is relatively safe to use for a couple of years and it gives people breathing-space to decide how best to move forward...

How does anti-CD20 work?….Boy are we making it complicated

Understanding CD20+ T cells in MS Anti-CD20 monoclonal antibodies have shown some efficacy in patients with multiple sclerosis (MS). Although CD20 is mostly expressed by B cells, a subpopulation of CD20+ T cells has been identified. The origin of CD20+ T cells and their role in autoimmune diseases are not fully elucidated. Now, Ochs et al. found that T cells can acquire...

HSCT verses cyclophophamide for progression is no better.

Cyclophophamide is an anti-cancer drug that is not approved for MS but is used sometimes off-label. This inhibits relapses, as shown in this paper, but not quite as good as abalative HSCT stem cell therapy (This is where you get rid of the immune cells and replace the immune response using bone marrow stem cells). This inhibits relapses well, but with regard to progression they are as good or as...

The problem for nutriceuticals

You wrote to me to suggest that supplements work…. but this highlights a problem for nutriceutical studies. There is no patent protection to be had and so pharmaceutical companies are not willing to spend big bucks to do a study where anyone can come along and sell the product without any outlay for drug development. So someone says let’s do a prevention study with supplement X…...

What is the cancer risk with MS Disease-modifying treatments?

This question comes up time and again with MS treatments and probably is one of the most important negative selection choices secondary to PML for DMTs in MS. Every time a new drug is presented to the clinical community, the cancer stats are heavily scrutinised. For example, with ocrelizumab the greater number of breast cancers in the treated arm versus placebo impacted on who ultimately received...

Teriflunomide fails in Paediatric MS for primary outcome

Teriflunomide (Aubagio) holds a license for adult RRMS with an efficacy of roughly 30% relapse rate reduction versus placebo (dummy tablet). The long awaited study in paediatric MS (TERIKIDS study) recently published, however has failed to meet its primary endpoint – time to first confirmed clinical relapse in the teriflunomide group vs. placebo. The probability of first confirmed relapse...

B cell depletion with ofatumumab and a new-kid-on the (CD20) block with the appearence of “Ubli” at ECTRIMS2021

Ofatumumab antibody depletes B cells. Sure it is going to deplete them T cells too . It depletes B cells, so no surprise there (see below). It is given every month to wipe away the B cells in the blood. What does it do to memory B cells? I have no idea but would say that it is likely. What does it do to CD20 T cells…I probably would answer “I don’t care” but if the Guru of...

ChariotMS – we’re rolling !

And we’re off… Almost exactly three years after submitting our outline application to the NIHR-EME, the first site initiation visit of ChariotMS will take place TODAY at my home site, The Royal London Hospital. We are expecting the first of 200 people with advanced MS to enrol in June. And as the remainder of 20 sites across all nations of the UK will open over the next three months...

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