Tagalemtuzumab

#MSCOVID19: ABN Guidance Update

Barts-MS rose-tinted-odometer: ★★★ The ABN have updated their COVID-19 guidelines, which are beginning to move towards the evidence. However, the guidance on cladribine is not supported by the evidence nor the science, i.e. how cladribine actually works and its impacts the immune system. The latest guidance states “the risk of severe COVID-10 disease is increased for many months after...

Journal Club: whack-a-mole

The latest Barts-MS journal club describes and discusses the Whack-A-Mole strategy dealing with secondary autoimmunity post-alemtuzumab treatment. It is based on the paper below. Meltzer et al. Mitigating alemtuzumab-associated autoimmunity in MS: A “whack-a-mole” B-cell depletion strategy. Neurol Neuroimmunol Neuroinflamm. 2020 Aug 7;7(6):e868. doi: 10.1212/NXI.0000000000000868...

Beyond the B-cell: cognitive dissonance

I continue to be amazed when I hear senior MS neurologists make the claim they have never prescribed alemtuzumab or referred any of their patients for HSCT and don’t intend to do so either. These same neurologists seem to be happy with natalizumab and ocrelizumab as their #1 high-efficacy go to DMTs. When I challenge them with the exceptional longterm outcomes for pwMS treated early with...

Alemtuzumab Epiphany

Prof G is in a melancholic mood. Why? This week I am doing video consultations with all the volunteers who participated in the pivotal phase 3 and 10-year extension studies of the alemtuzumab clinical trials. My objectives are three-fold. Firstly, to make sure they are referred back into a routine NHS MS service and are not left floundering without follow-up. Secondly, to complete a few exit EDSS...

Alemtuzumab replay

Sometimes it’s better the devil you know than the one you don’t. Alemtuzumab came into disfavor following the European Medicines Agency (EMA) Article 20 procedure surrounding certain rare side effects. There couldn’t have been a deeper grave to crawl out of. In my mind the group most to gain from alemtuzumab have always been those early on in their disease before disability sets...

Alemtuzumab Update

As promised to all my colleagues in the Middle East and North Africa, who attended my alemtuzumab update webinar this evening, you can view my slides and download them from my SlideShare site.

CoI: multiple

Post-partum relapses after alemtuzumab

One of the problems of immune reconstitution therapies (IRTs), such as HSCT, alemtuzumab and cladribine, is nagging worry that at some time in the future your MS will reactivate. Some people with MS (pwMS) try and avoid potential triggers of disease activity, for example, vaccinations and pregnancy, particularly the post-partum state. Unfortunately, there is some evidence the latter may trigger...

Unaccountable

The European Union and its Institutions have been heavily criticised as part of the Brexit debate as been undemocratic and unaccountable to the man or woman on the street. However, it is only when their decisions impact on you, or your patients, that you realise that these critics have a valid point.  Last week the European Medicine Agency’s safety committee (PRAC or Pharmacovigilance Risk...

Are IRTs ahead of their time?

I am beginning to think that immune reconstitution therapies or IRTs are ahead of their time. Many neurologists, people with MS (pwMS), payers – particularly fee-for-service insurance companies – and the regulators are unable to get their heads around how these agents work. In addition, a few recent review articles, written by colleagues, cast doubt on this treatment strategy and the...

The Phoenix

Like a phoenix rising from the ashes for the third or fourth time, alemtuzumab is given yet another life. I am sure many neurologists and people living with MS will be grateful, but I don’t agree with its positioning. EMA’s safety committee or PRAC has handcuffed alemtuzumab and is restricting it for adults with relapsing-remitting multiple sclerosis that is highly active despite adequate...

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