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...
Barts-MS rose-tinted-odometer: ★ I know it sounds like a cliche but Catch-22 would definitely be on my list of most impressionable books I read as a teenager. I liked it because of its dark satirical humour, it was written in the third-person and it taught me how absurd war actually is. Catch-22 (and the Great Gatsby) also taught me if you love a book you should never watch the movie; the...
Barts-MS rose-tinted-odometer: ★★ “I think the people of this country have had enough of experts”, Michael Gove, June 2016. Of the many positive things to come out of the COVID-19 pandemic and our response to it is the end of the era of denigrating the expert. Yes, expertise and in particular deep expertise really matters and that applies to the diagnosis and management of multiple...
Barts-MS rose-tinted-odometer: ★★★★★ Did you watch the anti-CD20 debate on the triMS-online platform yesterday? The question that was asked was ‘Can we use anti-CD20 therapies as immune reconstitution therapies rather than maintenance therapies?’. I am not sure the debaters answered the question. When I asked Anders Svenningsson, who is probably the world’s biggest adopter of anti-CD20 therapy...