Barts-MS rose-tinted-odometer: ★★★★★ (a London Grey day #666677) Can we use an anti-CD20 therapy as an immune constitution therapy (IRT), i.e. 2 years of treatment followed by no treatment unless there is EIDA (evidence of inflammatory disease activity)? This strategy is not new to the field of MS; this is how we use alemtuzumab, cladribine and AHSCT. So why not with ocrelizumab, ofatumumab or...
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...
Barts-MS rose-tinted-odometer: ★★★ (I am seeing blue and Spanish yellow today) Roche blue (#0066CC) & Novartis Spanish Yellow (#F7B516) Yes, I really do think that intrathecal (within the meninges that cover the brain and spinal cord) or CNS resident B-cells and plasma cells are pathogenic in MS. In other words, the cytokine or chemicals B-cells and plasma cells produce, in particular their...
Barts-MS rose-tinted-odometer: ★★ (Purple Haze Friday #7D7098; looking forward to the weekend) It is quite amazing how large and extensive the focal inflammatory lesion blindspot or scotoma is in the field of MS. I was on a call with a few American neurologists last week and they were saying how anti-CD20 therapy has transformed their MS practice. One neurologist claimed that 4 out of 5 of their...
Barts-MS rose-tinted-odometer: ★★★★★ (rose-red; a climbing rose with thorns) I have moved my treatment goal beyond NEIDA (no evident inflammatory disease activity) for my patients with MS. The new focus is on preventing end-organ damage. To achieve this we need to take off the blinkers that the Pharma industry has blinded us with. Our treatment target has to be smouldering MS, i.e. stopping...
Barts-MS rose-tinted-odometer: ★★ (amber; a sleep deprived colour somewhere between yellow and orange) It has become clear that the anti-CD20 therapies are more than just anti-B-cell therapies. Minority populations of both CD4+ and CD8+ T-cells and NK-cells express CD20 and are depleted after both rituximab and ocrelizumab treatment. It looks as if ocrelizumab may be more effective in...
Drum roll please!…. It was only a matter of time before someone designed this experiment. Albeit, it’s in an animal model, but the content is still by far the juiciest I’ve seen in MS research this year. The major finding of this work is that depleting B cells alone using anti-CD20s doesn’t get rid of all inflammation in the neuronal tissue. The authors of this work...
“Whatever choice you make makes you. Choose wisely” – Roy T Bennett, The Light in the Heart. Unfortunately, you can’t pick your race or whether you get MS, nor whether you have to deal with both. Racial differences in treatment response for health conditions is not a novel concept. When I was a trainee I was taught that it was harder to control blood pressures in African...
Barts-MS rose-tinted-odometer: ★★ In response to a question over the weekend about what has happened to the DODO and ADIOS studies. Both are alive and kicking. The more insightful question would be ‘how can I support both the DODO (double-dose ocrelizumab study) and the ADIOS (adaptive dosing ocrelizumab study) studies?’. Surely, the DODO and ADIOS studies are incompatible with each...
Figure: Anti-CD20s (A) rituximab (yellow), (B) ocrelizumab (red), (C) ofatumumb (green), (D) ublituximab (brown) The B-cell line up for MS now reads: rituximab, ocrelizumab, ofatumumab, and ublituximab. A fair number of you believe that these four treatments embody some magical powers, but I am about to demystify some of these beliefs and explain the science behind them. The three main take away...