Tagnatalizumab

To switch or not to switch that is the question

Barts-MS rose-tinted-odometer: ★★★ The one good thing about thinking aloud is that your colleagues’ chip in and provide feedback. Case 2 from my ‘ethical quandary post‘ is generating an important debate about whether to support this patient’s decision to switch therapy or not. As a reminder, this is the 40-year old woman who started natalizumab as a first-line therapy 11...

The age of innocence

Once upon a time there was a boy. He lived in a well-to-do neighborhood, had everything that he needed, his parents loved him and everything was possible. One day whilst playing football his leg gave way and he could no longer walk like his mates. This was the start of his journey into MS and adulthood. Age matters in MS. Pediatric MS typically refers to the development of MS before 18 years of...

Let’s get ready to rumble!

If the heavy weights of MS drugs go head to head in the boxing ring, it is anyone’s guess who will come out on top. The MS Base publication in 2019 states that starting on fingolimod, alemtuzumab or natalizumab is superior to glatiramer acetate or interferon beta. This March, the Italians have sneakily put together their own contest between fingolimod and natalizumab. You may say this one...

#MSCOVID19: summertime

To me three swallows make a summer; one from Sweden, a second from Iran and now a third from Italy. I have little doubt more will emerge soon. A few weeks’ ago I explained that having asymmetrical information is never a good thing. Tragically I have known about the data published yesterday on the Lancet’s pre-publication archive for several weeks. The new data shows that ocrelizumab-treated...

Natalizumab – new insights

I view the field of MS as being ‘Before Natalizumab or BN’ and ‘After Natalizumab or AN’ this vlog provides another important insight we have obtained from the reanalysis of the data from the original phase 3 or AFFIRM study.

CoI: multiple

#MSCOVID19 – natalizumab extended interval dosing

More questions around managing MS during the COVID-19 pandemic; this time in relation to natalizumab (Tysabri) dosing. The COVID-19 NHS crisis is a double-whammy for pwMS. First, it is redeploying staff away from MS services to work on the frontline. Secondly, the message has gone out to stop pwMS coming to NHS hospitals, or even connecting with other healthcare facilities such as GP practices...

#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...

Do no harm

Primum non-nocere is a Latin phrase that means “first, do no harm”.  On the tube this morning I recognised one of our medical students reading Henry Marsh’ book “Do no harm”.  He is a semi-retired neurosurgeon, turned author, who uses his past patients to discuss ethical dilemmas and to criticise the NHS. His book does showcase the life of a surgeon, warts and all.  It is clear that to be a...

The Time-to-Think DMT

At an MS Masters Forum in Rome yesterday I was teaching MSologists and MS clinical nurse specialists using a recently created board game, which I like to think of as being MS Monopoly. MS monopoly is based on a game of chance that lets you discuss case scenarios and make treatment choices. Then you roll a dice, which determines the outcome of your choice.  Two things emerge from playing the game...

8 picograms

What does your DMT say on the tin?  Some advice on what to say to your neurologist, or HCP, the next time you see them; “I now know why I am not expecting to get anything more out of this DMT than what it says on the tin”.  Our current crop of DMTs can only do what they are designed for, i.e. stopping the focal inflammatory activity or new lesions from forming.  They are not designed to switch...

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