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Re-evaluating the benefit-risk of high-efficacy treatment in MS

…ow being investigated. Early use of high-efficacy DMTs may also permit drug-free intervals (as with cladribine) or de-escalation to a less intensive maintenance regimen. Such adjustments may serve to facilitate the shift to the earlier use of high-efficacy DMTs as the new standard of care. Survey 1. In what RRMS patients would you generally initiate treatment with a high-efficacy DMT? I would not initiate treatment with a HE DMT Only patients with…

Bivalent COVID booster approved in Canada

…en/health-canada/news/2022/09/health-canada-authorizes-first-bivalent-covid-19-booster-for-adults-18-years-and-older.html). The bivalent booster (mRNA-1273.214) includes antigen from the original CoV-2 virus strain and the Omicron BA.1 variant. SPIKEVAX Bivalent (elasomeran/imelasomeran) is administered as one 50 mcg intramuscular injection at least four months after a primary series (two injections) or a booster (i.e. as a first or second booster…

Three biomarkers of DMT adverse effects proposed

…imaging with the mitochondrial translocator protein (TSPO) radioligand 18F-GE-180 in conjunction with 3T MRI (Mahler et al. Brain 2021;144:2683-2695). TSPO is a non-specific marker of inflammation. It is increased both in PML and MS lesions but the pattern is different: reticular accumulation of TSPO-expressing phagocytes in PML vs. a more homogeneous distribution in MS lesions. PET imaging detected enhanced TSPO uptake in PML lesions early on (e…

CLINICAL CASES IN MS – CASE 6: DIAGNOSTIC DILEMMA

…ar-old shipping manager at a local warehouse. He is married and has a three-year-old daughter. He presents in April 2021 following an episode of right sided vision loss, with minimal pain. Exam showed visual acuity 20/400, loss of colour vision and an afferent pupillary defect. The rest of his neuro exam is normal. Brain MRI revealed MS-like white-matter abnormalities with a moderate burden of disease and evidence of right optic neuritis (T2 hyper…

Is a cell-depleting DMT safe prior to HSCT?

…ections or other complications when administered prior to aHSCT. The study examined data for 104 MS patients (mean age 30.8 years) who had received a DMT <6 months prior to undergoing aHSCT in the period 2011-2021. Mean duration of MS was 5.8 years. Median EDSS score at baseline was 3.0 (range 0-6.5). The mean number of prior DMTs was 2.1; 11.5% patients were previously untreated (aHSCT is a first-line option in Sweden) and 16.3% had received >4 D…