CategoryTrials

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...

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...

RUN SIZOMUS RUN!

Mama Always Said, Life Was a Box of Chocolates. You Never Know What You’re Gonna Get – Forrest Gump, 1994  A few years back Prof G, whilst talking about MS at a conference was approached by Takeda Pharmaceuticals on whether we would be interested in targeting plasma cells; probably one of the last frontiers in MS. The ideas started spinning from there. Roll forward...

Can’t Neuros just flipping Read!

This is one of those posts where I bring our profession into disrepute. The neuros are gods when they do something that works and yes I am not worthy when it comes to licking the bosses boots, but eventually you have to crack. I have been reporting year after year as a stocking filler for when ProfG or some other neuros posts something of interest. Therefore I have read a lot and you see this...

Let’s get ready to rumble!

If the heavy weights of MS drugs go head to head in the boxing ring, it is anyone’s guess who will come out on top. The MS Base publication in 2019 states that starting on fingolimod, alemtuzumab or natalizumab is superior to glatiramer acetate or interferon beta. This March, the Italians have sneakily put together their own contest between fingolimod and natalizumab. You may say this one...

Clinical Trials in progressive MS. Is it time to bin Neurofilament Light?

Many year ago I was having a conversation with NDG and neurofilaments and she said neurofilament light was the wrong outcome. I didn’t really get it because, surely as a nerve dies it releases its contents (i.e. neurofilaments). However, I now think that neurofilament light is like a global MRI scan. If you can find neurofilaments then there is a lesion somewhere in the CNS. You may not...

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