Tagimmune reconstitution therapies

Cladribine Retreatment

What do you do when you get recurrent disease activity on cladribine? I am repeatedly being asked what to do about disease activity in patients treated with cladribine. The following is my suggestions on how to approach this thorny issue. As you know disease activity on immune reconstitution therapies (IRTs) don’t necessarily mean you failed or are failing the therapy. Disease activity could be...

Filgrastim for natalizumab-induced PML

PML, JCV infection Natalizumab (aka Tysabri), is one of the hard hitters in the DMT world and owing to its mechanism of blocking the ingress of immune cells into the brain, works quickly – achieving control in as little as 4 weeks. In the AFFIRM study, natalizumab reduced the rate of clinical relapse by 68% in the first year! But, one of the drawbacks of stopping the immune surveillance of...

Playing second fiddle to the Swedes

Why can’t we use anti-CD20 therapies as immune constitution therapies? For some years we have been promoting our Barts-MS Essential DMT list to treat people with MS (pwMS) in resource-poor environments. One of the big guns on our list has been rituximab (anti-CD20).  One of the problems is that rituximab at a dose of 1g every 6 months is still too expensive to accessible for the vast...

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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