- Patient A is 12 years into their illness and was treated early in his disease course, they had no disability and continue to perform at a high level as a professional golfer.
- Patient B was initially started on interferon-β1a therapy and went on to have two disabling relapses on this treatment which resulted in a degree of fixed disability prior to the start of alemtuzumab. 10 years into their disease course they have moderate disability and daily symptoms of spasticity in his legs which impair their quality of life.
- These two contrasting cases highlight the difficult decision of when to start potent immune modulating therapies for multiple sclerosis in young adults who appear well early in their disease but have the potential to rapidly accrue irreversible disability from future relapses.
Alemtuzumab is an effective DMT, but there appears to be a constant flow of comments circulating about its therapeutic value. This view in my opinion is misguided. The question is not whether it works as it does,the question is the risk:benefit issues
This report of two civilians (civies) by ProfG & C highlight some stark consequences. With active MS you may have the choice of Lemtrada, unless you have a risk-averse Neuro and worryingly an NHS trust that is rationing your access to drugs.
This study highlights the importance of aiming for and achieving NEDA, it may occur with a low efficacy DMT, but the chances are it may not. Some people on the blog have argued that relapses are not important in the prognosis of MS. This study highlights that this is not the case. Aim for NEDA it is risky not to.
CoI: Prof G was an author of the paper. Multiple