Tagfingolimod

#COVIDMS Will COVID-19 mutate?

Human coronaviruses are predominantly associated with respiratory tract infections. This group of viruses includes viruses that cause severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and now the COVID-19 pandemic. One human coronavirus HCoV-OC43 is generally associated with mild upper respiratory tract infections, although it has been shown to have neuroinvasive...

Cost effectiveness of cladribine vs fingolimod in Portugal

Firstly, this is not about money (I say this without a tell as my accountant taps away at their calculator nonchalantly). Really, this concept of cost-effectiveness is only obtrusive if you dislike politicking in any form or kind, or you’re British. The easiest way to understand cost-effectiveness models in healthcare in my view is to understand the principles of bartering. In bartering...

What is advanced MS?

Barts-MS rose-tinted-odometer – zero stars Someone recently asked what is advanced MS? I suspect they have been getting frustrated with our use of this adjective without a clearer understanding of what it really means. To find out if you have advanced MS you need to put yourself through a battery of stress tests to find-out much reserve you have left to deal with MS and life in the future...

JCV index and the effect of DMTs

JCV STRATIFY (anti-JCV antibody) test has been utilized for more than decade to de-risk natalizumab treatment and other DMTs for risk of PML (Progressive Multifocal Leukoencephalopathy). Cases of PML have occurred predominantly in natalizumab, but less commonly with fingolimod (Gilenya), dimethylfumerate (Tecfidera) and rituximab. A high JCV antibody index value indicates that the risk of...

Is fingolimod safe in pregnancy?

Safety of Disease Modifying Treatments (DMTs) whilst pregnant and breastfeeding (from Practical Neurology journal) The risk-mitigation strategies surrounding DMTs in pregnancy haven’t come that far over the last two decades. So far, we have abstain from pregnancy, stop treatment prior to pregnancy, stop if you discover that you’re pregnant, or switch to Copaxone during pregnancy...

Japan epicentre of an Asian MS epidemic

I am about to return from a short MS meeting in Tokyo. This was my first exposure to Japan and Japanese culture. It is everything and more than I expected. I am beginning to get a sense of what ikigai means. Ikigai translates ‘to a reason for being, encompassing joy, a sense of purpose and meaning and a feeling of well-being’. Ikigai derives from iki, meaning life and kai, meaning the realisation...

Warts and all

I have previously made the case that warts, both cutaneous and genital, are a relative contraindication to alemtuzumab therapy. I had one patient who has a torrid time with cutaneous warts after receiving alemtuzumab treatment. Fortunately, her immune system rejected them when it reconstituted and she is now fine. At least with alemtuzumab and other IRTs (immune reconstitution therapies) you can...

MS DMTs that hit the regenerative note

Santiago Ramon y Cajal Who said that the brain doesn’t regenerate? Well, it was the neuroscience Dogma as far back as philosophy. But, not in certain quarters; Santiago Ramon y Cajal (1852-1934), widely believed to be the father of modern neuroscience in his treatise ‘Degeneration and Regeneration of the Nervous System’, alludes to the potential of the brain to regenerate in the...

Beyond NEDA

Prof G are we being lulled into a false sense of security by being told that we have no evident disease activity (NEDA)? A patient of mine, who I have been looking after now for over 11 years, asked me in clinic a few weeks ago why despite being NEDA for 6 years, on a highly effective maintenance DMT (fingolimod), has she gone from being able to run 5-10 km to needing a stick and barely managing...

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