Uric acid (UA) is the end product of purine metabolism in which adenosine, guanosine and inosine are broken down to form xanthine, which is converted to UA by xanthine oxidoreductase. In most mammals and other species, UA is further metabolized to allantoin by urate oxidase. In humans, a mutation to the UOx gene early in our evolution resulteprogred in an absence of functioning urate oxidase. In consequence, UA levels are as much as 10-fold higher in humans compared to other species (Alvarez-Lario & Macarron-Vicente. Rheumatology 2010;49:2010-2015).
Neurology
Alemtuzumab: phase III results
April 10, 2013The results of the phase III trials, CARE MS-I and CARE MS-II, show that alemtuzumab significantly reduces relapse rate by about 50% compared to interferon-beta-1a SC (Cohen et al. Lancet 2012; 380:1819-1828).
Disease activity-free rates at 1 and 2 years
March 23, 2013REPORT FROM THE AMERICAN ACADEMY OF NEUROLOGY (AAN) ANNUAL MEETING, SAN DIEGO, CA, MARCH 16-23, 2013 – An emerging metric in MS research is the proportion of patients who are disease-activity free (DAF), defined as no relapses, no MRI activity (T2 or Gd+ T1 lesions) and no sustained EDSS progression. One of the first uses was an analysis of the AFFIRM dataset, which reported a two-year DAF rate of 37% with natalizumab versus 7% with placebo (Havrdova et al. Lancet Neurol 2009;8:254-260).
Second-line switching: three reports
March 23, 2013REPORT FROM THE AMERICAN ACADEMY OF NEUROLOGY (AAN) ANNUAL MEETING, SAN DIEGO, CA, MARCH 16-23, 2013 – Natalizumab is commonly used following first-line treatment failure/intolerance, but switching may be advisable after two years in patients with anti-JC virus antibody positivity. However, switching therapies is challenging in practice due to the risk of increased disease activity upon natalizumab withdrawal.
CCSVI: has the balloon burst?
March 23, 2013REPORT FROM THE AMERICAN ACADEMY OF NEUROLOGY (AAN) ANNUAL MEETING, SAN DIEGO, CA, MARCH 16-23, 2013 – An Alberta study reports that patients’ interest in venoplasty to treat chronic cerebrospinal venous insufficiency (CCSVI) appears to be on the decline (Metz et al. AAN 2013; abstract P05.183).