Sunday, 1 November 2015

Unrelated Blogger Comments November


If you have questions unrelated to the links this is the place for you

79 comments:

  1. I noticed this report on the BBC about a woman with MS who was able to walk again after taking HIV drugs: http://www.bbc.co.uk/news/uk-england-sussex-34659771
    I wonder if the timing of this is important? Is this a precursor to good (or a spoiler for bad) news about the INSPIRE trial results?

    ReplyDelete
  2. A couple of weeks post-Lemtrada now, doing much better! I went to work last week. Looking forward to seeing my numbers on Friday.

    I'm wondering, aside from the thyroid issues, is anyone doing work on recovery issues with alemtuzumab? Neuros seem to just be winging it on the washouts and relapse issues, but it would be nice if there were guidelines based on research. Also nice if someone was working on correlating the blood work with who responds and who doesn't if possible. Like, if your B cells rise too fast post-alemtuzumab, does that put you in the risk category for a third or fourth round? (Or non-responsive?) If they're collecting all this data...

    ReplyDelete
    Replies
    1. Not much work being done on this front. The B cells coming back early may be the determinant in the systemic autoimmunity. The question you should be asking the Genzyme bods is whether neutralising antibodies to Alemtuzumab impacts on efficacy and redosing?!

      Delete
    2. Thank you, Doc. G! Is there a test available for the antibodies or is this another thing no one cares to really provide?

      Delete
    3. It's available but not for routine clinical use that I'm aware of. I'm sure like anti-natalizumab antibodies this will make its way into the system.

      Delete
    4. "The question you should be asking the Genzyme bods is whether neutralising antibodies to Alemtuzumab impacts on efficacy and redosing?!"
      How would it be in Genzyme's interest to answer that question? Should that not be something that neuros should be discussing with their patients in addition to putting pressure on Genzymes and others to answer? Is that not something that could be answered by post use studies?

      Delete
    5. Neutralising antibodies do what is on the tin and neutralise...it will impact on efficacy and may cause infusion reactions, it is amazing that you get them with alemtuzumab seeing as they wipe out the immune system.

      As to blood work and who responds and who doesn't they haven't found anything in immune subset analysis, but you need to look at antigen-specific responses. NIHR weren't interested in funding this when we proposed this study.

      Delete
  3. Related: http://msj.sagepub.com/content/early/2015/10/28/1352458515614092.abstract?rss=1

    Anyone able to break this down for us Lemtrada patients? This seems like a very long term study.

    ReplyDelete
    Replies
    1. N Robertsons team used Campath and Alemtuzumab at their place. They had both RRMS and highly active RRMS in their cohort, ergo the redosing rate in at least 40% of patients. The baseline EDSS is higher than the drug trials with on average including those with an EDSS of 2. This then explains the mild disability progression observed at the end of 6 years. They did however have better reduction in relapse rate than the drug trial amounting to 90% vs 55 and 50% in care Ms I and II trials - wouldn't read too much into this as individual centres vary in what they get. They also noted that requirement for redosing also increases the longer the monitoring period is - which again is no surprise! I have been trying to get through the idea of being on a lesser DMT in the interim which can prevent this immune reconstitution, an idea which has not taken off in the MS community, to avoid this dance with redosing!

      Delete
    2. Same anon: well, I'm not really keen on going back.on DMT unless there's compelling evidence, even though I'm concerned about what I can do as a patient to get the optimal response from Lemtrada. For me, that was one of the selling points of the therapy.

      Delete
    3. Maybe I should have been more specific about the dance, not just the redosing but the systemic autoimmunity which also resets. Of course, I agree this defeats the point of the one off treatment and its convenience.

      Delete
    4. This is why I wondered whether it was especially important post alemtuzumab to make sure that you were full of vitamin D so that the immune system re constituted itself in a vitamin D rich environment. I know that Prof G feels that viatmin D is not going to affect your MS much once it is established, rather is god for bone health and general immune system support, but I wonder about a newly reconstituting immune system

      Delete
  4. Profs,

    There seems to be so much going on in the world of MS research at the moment - I can't keep track of everything which is underway. What should I be looking out for over the next 6-12 months e.g. will i hear about any neuro-protective trials or myelin repair trials? Thanks.

    ReplyDelete
  5. Would be a clue linking EBV infection, genes and autoimmunity? http://www.cell.com/ajhg/abstract/S0002-9297(15)00372-9

    ReplyDelete
    Replies
    1. Cinara, these GWAS studies simply point out an association and do not demonstrate a causative link. In this case that would be a causative role between the viruses and how efficient the antigen presentation which leads to the autoimmune disorder. It is possible that more than one antibody response may be contributing.

      Delete
  6. If possible, I would like to know more about advances with remyelinating treatments. Also, is there any data regarding the side effects seen in the OPERA I and II trials? From what I understand, the safety profile is decent (good?) but some details would be great. Thank you.

    ReplyDelete
    Replies
    1. Type in remyelination in the search and you will find the posts.

      The side effects of ocrelizumab were posted for a few nano seconds at ECTRIMS and we need to wait for the publication. ProfG knows the data but is gagged

      Delete
  7. I wonder if pwMS have a smell?
    I find it iteresting the wife of a man with parkinsons was able to tell his smell had changed. Research put her nose to the test and she tested 100% correct for some other people with parkinsons. It could be another avenue for assisting diagnosis.

    http://www.bbc.co.uk/news/uk-scotland-34583642

    Also dogs that can smell some diseases.

    ReplyDelete
    Replies
    1. Now you are getting into the Realms of ProfHawkeye who has a scratch and sniff card in his pocket as it does indeed pick up Parkinsons

      Delete
    2. Yes an MS sniffer dog.
      It would be interesting to see if the lady who could smell parkinsons can smell a distict odour of MS. Replicate the parkinsons research but with MS. Get MSers to wear T-shirts for a day.

      Delete
    3. Giant rats in Africa used to sniff out land mines and also to detect TB disease in mucus samples. They are able to work very fast detecting TB.
      Mousedoctors could it be possible to train these rats to detect MS?

      Delete
  8. Anon 5:30 and Aidan
    Paper by Sadiq and intrathecal Methorexate. The paper you cite is based on 121 people, please tell us where the 500 figure comes. I have treated this as an advert and have removed it. Prove me wrong to do this

    The question is whether there is efficacy? The paper was published in 2010 based on a 1 year follow up which is too short to really assess efficacy in progressive MS. Most people were stable over the year but as many people declined as didn't. So there must have been 4 years follow-up what is the data.

    Yes it is interesting but there has been enough time for the study to tested properly and proper trials should be done if it is indeed efficacious

    ReplyDelete
    Replies
    1. Sorry MD,

      I had not checked all figures before replying. But I am a patient there.

      Delete
    2. Dear Aidan
      Thanks for the reply, it was not your post that needs varifying

      Delete
  9. I am Anon 5:30. Not trying to advertise. The 500 figure comes from their website and a phone call to their offices. They continue to treat patients with IT methotrexate. Since there is no followup publication and 5 years have passed, I would like to know if anyone knows any more about them or their treatment, possibly through professional interactions that those of you may have.

    I recently finished a 3-year trial for SPMS & want to try something else and possibly avoid what is coming. Just looking for whatever info is available, to decide whether I should visit them.

    ReplyDelete
    Replies
    1. Thanks for responding, why not ask them for follow-up data and whether there are plans to do a proper trial. A quick search of their site with methotrexate did not reveal 500

      Delete
  10. I thought this was a good summary of the existing drugs and their impact on disease progression: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464731/

    It is grim reading, but important if you are to have a proper discussion with your Neuro.

    ReplyDelete
  11. Have you heard any updates regarding the clemastine fumarate trial (which, from my understanding, concluded several months ago)?

    ReplyDelete
  12. I'd also love to hear about the clemastine fumarate trial. Information has been virtually non-existent!

    ReplyDelete
    Replies
    1. i would not tell you even if i knew anything. It is not correct etiquette that I spill someone elses beans You have to wait until they talk about it or until the paper is published i'm afraid

      Delete
  13. MD - is it common in cases like this for a paper to never be published? I'm just wondering if there's a real chance that the results may never be known.

    ReplyDelete
  14. There seems to be two types of monocytes ...Would have to expand the positive CD16 monocytes something to do in the pathogenesis of MS, or not?
    http://onlinelibrary.wiley.com/doi/10.1111/imm.12456/abstract?systemMessage=Wiley+Online+Library+will+be+unavailable+on+Saturday+7th+November+2015++from+10%3A00-16%3A00+GMT+%2F+05%3A00-11%3A00+EST+%2F+18%3A00-00%3A00+SGT+for+essential+maintenance.++Apologies+for+the+inconvenience.

    ReplyDelete
  15. Team G, could a relapse happen after a fracture or injury such as a fall? I read that bone and the immune system interact closely during fracture healing.

    ReplyDelete
    Replies
    1. Let me rephrase my question.. Could a fracture or injury trigger a relapse? thanks.

      Delete
    2. "Stress" has been linked to triggering relapses, the specific causes which lead to this are varied.

      Delete
  16. Any research into secondary autoimmunity after alemtuzumab and outcome/effectiveness of drug? Ie someone who gets thyroid problems 6 months after first dose are they more or less likely to be a responder than those that don't get autoimmune problems? Many thanks

    ReplyDelete
  17. I noted a couple of blogs about the rebranding of off patemt drugs. Did a Conservative minister of Health Alistair Birt really fillibuster the private members bill? Has the man no shame? On the one hand the Governments says the NHS is broke then on the other hand we have this.

    Read the article in The Independent. Yes it is a contentious issue ibut is this approach the right answer?

    ReplyDelete
  18. Oops, here is the article http://ind.pn/1kyZs2j

    ReplyDelete
  19. Team G I have been reading the vitamin D increases serotonin is this correct?

    Interestingly I read that SAD can be successfully treated with serotonin reuptake inhibitors, which increase the availability of serotonin in the synapses of the brain.

    ReplyDelete
  20. Hi Peeps,

    Still here and Vicky still battling pain. What do we make of this one ? .....

    http://www.nrronline.org/article.asp?issn=1673-5374%3Byear%3D2015%3Bvolume%3D10%3Bissue%3D10%3Bspage%3D1570%3Bepage%3D1571%3Baulast%3DRavera


    Regards as always.

    ReplyDelete
  21. It is often suggested on this blog that the general neurologists of the UK are very conservative and seem to be behind wit the times in terms of MS research. What can be done to address this issue? Do the MS specialists provide enough education to the generalists? Is there a system in place for you to update your colleagues on a regular basis?

    ReplyDelete
    Replies
    1. There are many avenues for this through conferences, courses, journals etc. This may not be the issue...

      Delete
    2. What do you think the issues/barriers are? Why are the generalists so conservative? How can we overcome this? I would like to think that eventually people in the uk can get timely and appropriate access to treatment.

      Delete
  22. Dear All,

    Any data on Natalizumab and blood clots? Just been DXed with one last night. Had a clot after a bad rugby tackle six years ago, but nothing since then. Not sure if tysabri has played a role.

    ReplyDelete
    Replies
    1. There's no evidence that natalizumab interferes with the coagulation cascade. Having said this evidence of a previous DVT itself is a risk factor for DVT.

      Delete
  23. Dear All,

    Do you have any data on Tysabri and blood clots?

    ReplyDelete
  24. An article about metabolic dysfunction in a brain like mine. http://www.jneurosci.org/content/35/45/15170.short. Could it has therapeutic implications? Should we take more vitamin B12?

    ReplyDelete
  25. I saw that you removed your post on Debbie. Maybe it is for the best, things
    were getting too emotional. Still It made me want to shout about how I feel
    being a MSers.

    Before my RRMS diagnosis, I used to think that in one year I might not be able
    to do the things I am able to do today; I know now that I won't. I degenerate fast,
    faster than control people. You might think it is a weakness. Some days -yes-
    I feel so tired and depressed that I do not want to leave my bed. Most days
    -no- when I manage to get out of my bed drinking coffee feels like delicious, walking feels
    like an extreme sport and pissing feels like an achievement. I am enjoying
    every seconds of my day more than before. And this is making me stronger than
    I ever was, there is no reason why it could not be the case for you.

    ReplyDelete
  26. Evening guys.
    I read about this today and thought it fascinating: Temporarily opening up the blood brain barrier with ultrasound, to allow medication into the brain. Since most of the MABs are too large to pass into the brain, could this be the future of MS therapy - to allow us to target medications into the brain?

    Star Wars medicine!
    http://www.iflscience.com/brain/ultrasonic-screwdriver-used-open-blood-brain-barrier-treat-tumor-first-time

    ReplyDelete
    Replies
    1. Thanks Someone was tlking about this the other day I'll read and make a post

      Delete
    2. Thanks I've had a read and I think I will wait until it is done before making a post. Obviously targeting agents into the CNS are a precise location has immense potential and maybe it is the way to get antibodies such as anti-lingo into the brain. But it is only being trialed and the results are more important that the "we are going to do". In the past mannitol has been used to transiently open the blood brain barrier.

      Delete
  27. Studies on genetic factors actually on regulatory genes and what they mean are very important but how to translate them into practice, and to look only to the T cells, even when referring to other autoimmune diseases? http://www.ncbi.nlm.nih.gov/pubmed/26560356

    ReplyDelete
  28. I have been takeing 20,000 of the biotin since I heard about I all most wont to say am not getting worse, have you heard any more on ths?

    ReplyDelete
    Replies
    1. The work used 300mg/day of biotin, and I haven't seen the ECTRIMS data published yet. This would be phase II data. Reproduction in a larger Phase III study would be useful.

      Delete
    2. thanks can you tell me the difference meaning a lot or little the 300 mg viruses. 20,000 mcg. I read we in usa will be able to buy the higher strength next year. I bet if theres any thing to it it wont happen in usa. can you image what it would do to are pill company's

      Delete
    3. 20,000 mcg (micrograms, 10^-6 g) is 20 mg (milligrams, 10^-3 g)

      Delete
  29. I visited my GP today for something non MS related and we also discussed MS. I raised the importance of GP's recognising MS symptoms in people who have not yet been diagnosed with MS.

    I said I would be happy to talk to GP's and junior doctors at the surgery about my experiences and the GP said they may take me up on my offer. If I do get the chance to discuss my MS further I will include 'Brain health and time matters'.

    ReplyDelete
  30. Would be possible for a non remyelination be treated as a "defect" in the production of myelin by oligodendrocytes, regardless of inflammation in MS?http://www.nature.com/ncb/journal/vaop/ncurrent/full/ncb3271.html

    ReplyDelete
  31. There was something on the news today about the benefits of hydrotherapy for MS. The MSers in the programme were saying it has helped their MS a lot.

    I found this article from 2011, Hydrotherapy for the Treatment of Pain in People with Multiple Sclerosis: A Randomized Controlled Trial.

    5. Conclusions

    According to these results, a 20-week Ai-Chi aquatic exercise program produces a significant pain reduction in MS patients that lasts for 10 weeks after the end of the program. It also improves other MS-related symptoms, including disability, depression, and fatigue. These effects of the Ai-Chi aquatic program were superior to those of an equivalent exercise program in a therapy room.

    http://www.hindawi.com/journals/ecam/2012/473963/

    ReplyDelete
    Replies
    1. It would seem by these conclusions of 'a significant pain reduction in MS patients' aquatic exercise would be worth a try. Also that it improves 'disability, depression and fatigue'.

      I have pain from my MS. I didn't want to try swimming as I was concerned about swimmers ear infections. It is not a requirement to be able to swim in hydrotherapy and I would make sure I keep my head above water.

      Delete
    2. I've always swum and yes it helps not only pain, but gait. However, immediately after it's a struggle to walk. I use ear plugs, they have improved over the time I've been swimming.

      Delete
  32. A fifth year med student sat in on my GP consultation last week. I sat there thinking how much debt he was in before he starts the hard slog as a junior doctor. Shame on the government, we'll be searching abroad for qualified doctors to prop up our health service in a few years. Not to worry the MPs all have private health care.

    ReplyDelete
  33. The EBV work of Professor Michael Pender in Queensland was of great interest to me. Can anyone shed any light on its progress, or that of Gary the patient he was working with? I believe a phase I trial has been completed?

    ReplyDelete
    Replies
    1. I would know the latest news as well.
      Do you have any information Profs.?

      Delete
  34. A mild sensory relapse 9 months post second alemz course = bad prognosis?

    ReplyDelete
  35. MS sufferer should be allowed to die, says judge in landmark ruling: 19th Nov 2015

    http://www.theguardian.com/society/2015/nov/19/ms-sufferer-should-be-allowed-to-die-judge-landmark-ruling-multiple-sclerosis

    ReplyDelete
  36. EBV promoting "immortalization" of B cells by oxidative stress?http://www.nature.com/onc/journal/vaop/ncurrent/full/onc2015450a.html

    ReplyDelete
  37. Hey guys.

    Just thought I'd give you a heads up that BBC Panorama are about to run a documentary on HSCT, called "Can you stop my multiple sclerosis". It airs on 14th December on BBC1 @ 8:30pm (in the UK).

    I understand they've followed (at least one) patient with aggressive MS through the HSCT process at Hallamshire hospital in the UK, which is one of the international satellite centres for Dr Burt's MIST trial.

    I think you guys said you'd met with Profs Snowden and Sharrack recently - maybe you should line them up for a guest blog post or Q&A around the time this airs, as I'd expect it will generate a lot of interest and questions.

    Anyway, here's the write up from the BBC website:
    Can you stop my multiple sclerosis?
    One hundred thousand people in the UK have multiple sclerosis, an incurable condition that can result in permanent disability. Panorama has exclusive access to patients pioneering a crossover cancer treatment that has enabled some MS sufferers with paralysis to regain their movement.

    Sounds interesting. Hope they give it a fair rap. No doubt, as its the BBC, we'll have the obligatory pharma-funded numpty from the MS Society or the ABN on there providing a counter view (for balance) that it has a fifteen billion percent fatality rate and that everyone would be better off taking interferon beta instead, or some other such scare-mongering bullshit. But from what I gather, it's a positive take overall.

    Only speculating though - I haven't seen it.

    Anyway - good or bad - thought it may be interesting for you/your readers and maybe worthy of a blog post to bring it to everyone's awareness.

    Here's the link: http://www.bbc.co.uk/programmes/b06ss17g

    ReplyDelete
    Replies
    1. I think it's been postponed until January

      Delete
  38. I had read about investigations into the JCV, the Herpes Simplex virus, EBV and Champlobacter bacteria as possible triggers of the immune attack against the Oligodendrocytes. MSers I know personally who are positive for EBV and JCV as those know for certain tests were negative for virus 2 and those known to one or the other viruses ... Now I know a one- girl who has Herpes Simplex and MS and each time the herpes virus replicates and causes visible symptoms of Herpes she has an outbreak of MS ... A friend of mine read this publication and mine sent the link, I found very intriguing, EBV Promoting "immortalization" of B cells by oxidative stress? http://www.nature.com/onc/journal/vaop/ncurrent/full/onc2015450a.html

    ReplyDelete
  39. http://www.npr.org/sections/health-shots/2015/11/29/457255876/loneliness-may-warp-our-genes-and-our-immune-systems?sc=tw
    Does loneliness lead to MS? Does social isolation and loneliness exacerbate MS by immune dysfunction?

    ReplyDelete
    Replies
    1. "Loneliness is a crowded room
      Full of hopes and dreams turned to stone
      All together all alone...."


      Bryan Ferry

      Delete
  40. Any nearer to publication on the inspire trial? Rough guide to when we might hear something??

    ReplyDelete
    Replies
    1. Re: "Any nearer to publication on the inspire trial? Rough guide to when we might hear something?"

      The primary outcome was negative. We are in the process of writing-up and submitting two papers. Interesting biomarker data will be presented at a conference next year.

      Delete

Please note that all comments are moderated and any personal or marketing-related submissions will not be shown.