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Q&A July

This star sign is Leo so today we have a Lion fish

Sculpture from the East End of London

Disclaimer: Please note that the opinions expressed here are those of the author and do not reflect the positions of the Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust or Queen Mary Univeristy of London.

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Kind of Blue

Barts-MS rose-tinted-odometer: zero-★s (Feeling ‘Kind of Blue’ for a Saturday, midnight blue #191970) We have known for some time now that pwMS on DMTs who get COVID-19 seem to be at no greater risk of severe COVID-19 and death compared to the general population with the exception of pwMS on anti-CD20 therapies. This implies that anti-CD20 therapies either impact preexisting cross-reactive...

Booster.. Not good news for anti-CD20..Time to get thinking caps on quickly because the same old same old is probably not going to be good enough.

We can learn from other conditions and if they are seeing the same thing to MS they are more likely to be true. Here is a view on arthritis Fagni F, Simon D, Tascilar K, Schoenau V, Sticherling M, Neurath MF, Schett G. COVID-19 and immune-mediated inflammatory diseases: effect of disease and treatment on COVID-19 outcomes and vaccine responses. Lancet Rheumatol. 2021 Aug 27. doi: 10.1016/S2665...

Why I’m no longer talking to pwMS about wheelchairs

When newly diagnosed pwMS enter a clinic room, they have read up about MS and are often focused on the daunting idea of ending up in a wheelchair or having to use a zimmer frame. From natural history cohorts before disease-modifying treatments (DMTs) were introduced, we know that for an untreated pwMS it takes a median 11.4 years to reach EDSS 4/not being able to walk unrestricted anymore, 23...

Longer-term safety data on ocrelizumab

Watch does it say?.I dont know its behind a paywall. You spend the money to do the trials maybe the open access fee would be useful:-) Longer-Term Safety of B-Cell Therapy With Ocrelizumab in Multiple Sclerosis.Yeh EA, Bourdette D, Wiendl H.Neurology. 2021 Sep 2:10.1212/WNL.0000000000012716. doi: 10.1212/WNL.0000000000012716.  Safety of Ocrelizumab in Patients With Relapsing and...

The New Normal

Lab lessons: Read the documents and dont rely on the headlines You were talking about getting a vaccine after waiting for B cells to repopulate and someone asked “What was the number for the B cells that met the fully reconstituted level for you?” This asks the questions What is the normal Level of B cells? 2. Why may it be important to know? To answer 2 first. It is increasingly clear to me that...

Escalation from Low Efficacy RIP?

About Time! Paradigm shifts: Early initiation of high-efficacy disease-modifying treatment in multiple sclerosis.Hartung HP, Meuth SG, Thompson AJ.Mult Scler. 2021;27(10):1473-1476. doi: 10.1177/13524585211033190.PMID: 34472985 No abstract available. Clinical development of disease-modifying drugs for the treatment of multiple sclerosis (MS) has been exceedingly successful...

Same again from Sweden…The Hare arrives

This first surfaced many moons ago on SSRN as a preprint when only people taking anti-CD20 who were naturally infected were included. It suggested that most people made an anybody response when infected with SARS-CoV-2 (Only about 25% seroconverted on anti-CD20 (which has been shonw by many others) and not on anti-CD20) and that vaccines were not going to be a problem….How wrong that turned...

COVID-19 vaccination and brain inflammation, fodder for anti-vaxxers?

The whole pandemic is like watching a slow-mo rendition of the ‘The Good, The Bad, and The Ugly’, where Eastwood keeps repeating the same lines over and over. Then enter those who are actually slow on the uptake, the wannabe anti-vaxxers who may use this article as evidence for their ideals. So, how can I portray the findings of this case series as no more than a rare occurrence and...

I’m so sorry

Barts-MS rose-tinted-odometer:  zero-★’s (Black Monday #000000) I heard last week that one of my patients sadly succumbed to COVID-19. This is not the first person with MS to die of COVID-19 but is a reminder of how fickle life can be. I have contacted my patient’s partner to say how sorry I am. The question I am asking myself is; could this death have been prevented? Yes, almost certainly...

Mousey COVID lessons

You said Any thoughts on this study out of Yale? Israelow B, Mao T, Klein J, Song E, Menasche B, Omer SB, Iwasaki A. Adaptive immune determinants of viral clearance and protection in mouse models of SARS-CoV-2. bioRxiv [Preprint]. 2021 May 19:2021.05.19.444825. doi: 10.1101/2021.05.19.444825. PMID: 34031656; PMCID: PMC8142653. in sciece immunology What are implications for MSers and those on anti...

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