TagDMTs

The big-D (DMTs) instead of the big-C.

First the symptoms, then the diagnosis, then the therapy discussion. Clinicians and patients with MS are constantly facing dilemmas and challenges with a dose of fear. Common questions that concern the DMTs are: Could these drugs be as harmful as efficient? Given that these drugs affect the immune system in various ways, could severe adverse events such as cancer occur? Our recent analysis...

The Big-C

Barts-MS rose-tinted-odometer: ★★★★★ (seeing grey – it’s a very grey Saturday) Whenever you bring up the topic of using more effective DMTs or flipping the pyramid you get pushed back because of the potential risks associated with these treatments. One risk is the big-C or secondary cancers. It is therefore very reassuring that an analysis of the FDA adverse event reporting system...

Tickled pink

Barts-MS rose-tinted-odometer: ★★★ (seeing pink; tickled pink) Thank you for completing yesterday’s poll. It is quite clear that you, our blog readers, want us to prioritise the following changes to the way we prescribe DMTs in the NHS. The most important priority is for pwMS to access immune reconstitution therapies (alemtuzumab, cladribine and HSCT) early as 1st-line therapies for active MS...

DMT wishlist

Barts-MS rose-tinted-odometer: ★★★★★ (seeing green; the green shoots of spring) I was asked yesterday if I could have a wish and change three things in relation to the prescribing of MS DMTs in the NHS, which ones would I prioritise? Can you help? The idea is to make changes based on how we would want to manage MS proactively as possible and to give pwMS choice. The idea of this exercise is to...

Watchful waiting 2

Barts-MS rose-tinted-odometer: zero-★s (still seeing red) Did you know that MS disease activity defines if you are eligible for therapy and which therapy? The following is a list of definitions that are generally applied to MS in England.  Inactive: Patients with MS with no relapses or imaging features of disease activity in the last 2 years.  Active: Patients with active disease are defined...

Treating MS in an ageing population

Image from MSARDs As the entire world learns to embrace ageing, it brings with challenges for healthcare service delivery and economy. Although, MS is a disease of the young (median age of onset is 32) ageing looms in the horizon and cannot be blithely ignored. In some instances, the MS isn’t picked up until much later (the oldest patient I’ve diagnosed is 84 years old!), which raises...

#MSCOVID19 asymmetry

Many of my colleagues have criticised and reprimanded me for being over-enthusiastic in stating that immunosuppressive MS DMTs are relatively safe for pwMS if they happen to develop COVID-19 whilst on treatment. However, the issue has been asymmetry of knowledge. I have known that patients on DMTs who get COVID-19 are doing well. This is based on knowledge acquired from multiple sources albeit...

#MSCOVID19: vaccines and DMTs

So if you are someone with MS who is shielding or being very careful about social distancing and want to avoid getting COVID-19 you may be considering what your own exit strategy is. How do you de-risk yourself and prevent yourself from becoming infected with SARS-CoV-2?  At present, it looks as if the UK government’s strategy is to ring-fence you with people who are immune to SARS-CoV-2...

#MSCOVID19 – DMT update (2)

This week saw several bits of information appear that has led me to change my position on several DMTs in terms of their risk for pwMS during the COVID-19 pandemic. Firstly, the verbal update by Maria Pia-Sormani on the Italian cohort of patients with MS who had COVID-19. These figures were given during the iWiMS weekly COVID-19 &MS webinar. There are now 380 cases of pwMS and COVID-19...

Pandemic

Yesterday I had the experience of a patient with highly active MS pull out of being treated with ocrelizumab (Ocrevus) because of concerns around being infected with the coronavirus COVID19. I suspect this will be the first of many patients with multiple sclerosis to do so.  It is clear that COVID19 epidemic is now a pandemic, i.e. it has involved enough continents and countries to be considered...

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