Monday, 20 March 2017

#NeuroSpeak: blast from the past cladribine MOA

Telling complicated stories through slick Pharma-funded movies. #NeuroSpeak #MSBlog

Whilst we on the topic of critiquing slick videos on the modes of action of DMTs it may be a good idea to review the oral cladribine MOA video from 6 years ago; yes, it has been 6 years since oral cladribine was launched in Australia. 

The oral cladribine video is much longer than the Roche-funded anti-CD20 video you may have seen this weekend. Cladribine is a smart drug that uses very clever biochemistry to target T and B cells. Does the video do the job of communicating this or do we need to something simpler?


CoI: multiple and this video was funded by Merck

24 comments:

  1. The Roche video and this video are completely different. Roche talks about CD20 and this video does not even mention that. So based on the Roche video I would ask how cladribine differs from ocrelizumab which I know it does.

    Debbie

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    1. How does it differ....probably by about £10-15,000

      That is comparing generic to new pharmaceutical Movectro II to ocrevus probably similar I don't really know. Price wont be announced until EMA approves.

      If you read our paper the bet would be they work the same way
      http://multiple-sclerosis-research.blogspot.com/2017/02/ms-is-b-cell-disease-and-memory-b-cells.html

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    2. I have read the paper numerous times now. Cladribine is not in the chart and the videos above do not suggest it works via the CD20 pathway. I do agree that it seems similar in terms of administration and lymphocyte destruction but it would be nice to see data for cladribine side by side in terms of types of lymphocytes destroyed.

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    3. When the pivotal trial was published this data was not included, but the data is in my hands thanks to the EMA.

      I am pretty happy that the best way to describe the data is via an influence on CD19 B cells, unlike this video which is firmly in the T cell realm.

      Look at the level of T cell depletion and see how much further the B cell depletion goes down further in the video.

      The B cells come back but we have to remember the CD19 population are 5 to 6 or more differnt type of B cell. This s key to the mis- understanding that pharma has been spinning

      watch this space.

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  2. The message is there, and I do not think it needs to be simplified. The professors all in black with ties sound a bit old fashion, a professional voice only and full space for images would be better.
    As it does also clearly mention dosage schedule, galenical form, reference to clinical trial this Merck video is fully promotional (and be considered promotion to public). We usually keep MOA as non promotional, strictly speaking about the molecule biochemistry as the Roche video below.

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  3. In the Roche and the Merck videos the blood vessels look like Type 2/Type 3 in the Bristol Stool Scale (https://en.wikipedia.org/wiki/Bristol_stool_scale:-).

    Some interesting detail, but do we have the attention span to watch this?

    I have to say I do not necessarily agree with the interpretation presented here but is feeding us what we want to hear. T cells, T cells, T cells.

    It they did this in the ocrelizumab-age would the video be the same?

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    Replies
    1. I suspect we will be seeing the answer to this at ECTRIMS 2017

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  4. No, we don't have the attention span to watch this. I could not finish. :-)

    I suggest you do prof Jeremy Chat-away voiceover :-)))). I get a back to childhood and "Once Upon a Time...Life" feeling whenever I listen to him, don't know why...
    https://www.youtube.com/watch?v=tjFtXXLC2bs&t=14s

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  5. Very wooden presenters. And I don't like that it is one-sided, i.e. biased. No information on side effects? It comes across like an advert for a new face cream. But it did clarify to me that Cladribine has no effects on innate immunity - and innate immunuty might be a problem in progressive MS?

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  6. These videos are total garbage. They're adverts to make money. All these doctors are being massively paid for their endorsements.

    MS isn't a disease, it is a business.

    ReplyDelete
    Replies
    1. Of course they are adverts, infomercials.

      In fact many science papers are considered as advertisements (at least they used to be) because the authors paid page charges.

      They could be used for teaching purposes, if I think they are correct for the bits I want to use.

      Furthermore, we have no idea what the participants are being paid and even if they are being paid. However, if they have been asked to do a job, should they not be paid for their time? I would not expect my car mechanic to give 4 hours of their time for free, would you?

      Do you think the presenters of top gear do their car shows for free?

      It seems when every I have dealings with lawyers they get paid win or lose, do we compain massively.

      Likewise as far as pharma is concerned, their work is a business.

      This weekend I gave up my free time to present at "Digesting Science" www.digestingscience.co.uk for children with demyelinating diseases.

      The most amount of interst that was shown was by the parents of the kids. It was obvious to me that there were massive gaps in their knowledge, yet they were making descisons about their loved ones.

      These knowledge gaps were either because their neuros where telling them part stories or they were not learning properly.

      Videos can tell a thousand words and I am sure people watching them can get some idea of what is going on.

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    2. Ethically, the important thing is the person, or people, with MS. Their wellbeing. I don't think that is well-served by infomercials which neglect down sides, side effects, information on the fact that not everyone with MS will benefit from the product. Don't lecture people on how they should be oh so grateful to pharma, when pharma may - by your own or your MD colleague's admission elsewhere on this blog - be effectively blocking the discovery and development of a cure / antiviral for MS.

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    3. That was pure supposition and speculation on my behalf. Please don't read too much into it. thanks.

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    4. You also have to ask who are the videos aimed at. They are general knowledge with subliminal advertising for neurologists they are not infomercials about the drugs. That will be a different video. Should you be excluded from viewing them?

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    5. Excluded no; it is always good to have an honest interpretation and perspective with admission of failings and inadequacies from people who say what they mean and mean what they say.

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  7. Replies
    1. They usually use people from Yorkshire to advertise washing powder not Copenhagen or Newcastle:-)

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    2. :-) Thank you for correcting, MD

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  8. In relation of efficacy and safety where will cladibine's place to be? It will be a moderately, highly, very highly effective treatment, with good safety profile?

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    Replies
    1. It will be up there but depends on how we deplete

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  9. I find it sad that people seem to be proud of the fact that they don't have the attention span to watch a 6 minute video.

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    Replies
    1. I am not proud of anything, just stating the fact. Do people take pride in watching TV ads from the very beginning to the very end? :-)

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    2. We mute the TV at ad time. My Dad, who's got all the time in the world and is highly organised watches commercial channels behind time via HD recorder and fast forwards the ads out ;-)

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    3. Who said they were proud?

      Delete

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