TagNEDA

Anti-CD20 vs. Teriflunomide

Barts-MS rose-tinted-odometer: ★★ (seeing blue) When I state that the real MS is smouldering MS and that relapses and focal MRI activity are not the disease I really mean it.  PwMS who are NEDA-2, without relapses and with no new MRI lesions, but getting worse must have something going on in their brains and spinal cords. This is why we need to go beyond NEIDA (no evidence of inflammatory...

Are you tired of COVID-19 blog posts? If yes, then this letter is for you

Dear Blog Reader I spent 15 minutes on the phone with one of my patients who has secondary progressive multiple sclerosis. She was an avid blog reader but has stopped reading the blog because she can’t stand the constant barrage of posts about COVID-19 and vaccinations and she doesn’t understand the posts anymore. I think some other readers may share her views. This patient’s...

Neurofilaments: from a two towards a three-layered cake!

We are happy to announce that our new paper on how to use cerebrospinal fluid neurofilament light chain (CSF NfL) in daily clinical practice has appeared online (open access) in the journal of Neurology Neuroimmunology and Neuroinflammation.  In this paper, we have documented how the BartsMS team is already using for more than four years NfL values obtained with a lumbar puncture to advise...

Are IRTs ahead of their time?

I am beginning to think that immune reconstitution therapies or IRTs are ahead of their time. Many neurologists, people with MS (pwMS), payers – particularly fee-for-service insurance companies – and the regulators are unable to get their heads around how these agents work. In addition, a few recent review articles, written by colleagues, cast doubt on this treatment strategy and the...

My ‘Smouldering MS Clinic’

I finished yesterday emotionally burnt-out; “broken and useless, no longer working or effective” or “kaput” as the Germans would say. I did an all-day clinic with my registrar off sick; it was hard and brutal.  On my way home I wondered to myself if I should change the name of my MS clinic to the ‘Smouldering MS Clinic’. Virtually all of my patients had smouldering MS or as some of you would...

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...

A sequence of losses

Prof G has the MS community go it wrong? In this week’s NEJM there is an insightful perspective by Louise Aronson on ageing and driving. Aronson. Don’t Ruin My Life — Aging and Driving in the 21st Century. N Engl J Med 2019; 380:705-707. Louise quotes the American poet Donald Hall, who explains in Essays After Eighty how life is irrevocably and excruciatingly changed when a person must let go of...

What is end-organ damage?

Help! How do I manage progressive brain atrophy in a patient who is NEDA-3? End-organ damage is a catch-all phrase for the degeneration of the brain; it occurs as part of the ageing process that some consider pathological and others as a normal fact of life. I have hinted that I consider it both because end-organ damage is potentially modifiable via lifestyle modifications and pharmacological...

Beyond the B-cell

Do we have the right cell target in MS? Yes and no; we need a multicellular approach. Recently the attention in MS has been on the B-cell as if it was the holy grail of MS treatments. It is not. In several posts, over the last few weeks, I have made the case that the B-cell is important, probably as an antigen presenting cell, but it is not the ‘be all and end all’ of MS treatments. It is clear...

NEDADI or ‘Nee Daddy’ another treatment target beyond NEDA

Prof G do you think disability improvement is a reasonable treatment goal? NEDADI = no evident disease activity and disability improvement Two weeks ago one of my patients with PPMS, who we treated with off-label subcutaneous cladribine, came for her annual follow-up appointment. Despite being treated with cladribine over 2 years ago she has unfortunately progressed from EDSS 5.5 to 6.5. Her...

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