#TeachMS: new treatment strategies

If you are free this Thursday you may want to listen to Mark Freedman and me discussing different treatment strategies in relation to managing MS in the current environment. All of our discussions will be case-based. Please register as there are limited places available.

CoI: multiple

#MSCOVID19: round-2 a series of webinars

I would like to say thank you, thank you and thank you for your kind donations towards the Barts-MS coronavirus antibody study. With gift aid, we have now passed the £10,000 milestone and will be able to start the first phase of the study. This is great news.

To raise the additional money I won’t be running a double-marathon, but we have taken up your suggestion of hosting a series of webinars. We have not are not going to charge anyone as such for attending these webinars; instead, we will simply ask you to consider making a donation in kind towards our study.

“What is the real MS and why is it important to know the answer?” will be the first webinar, in a series of webinars, to raise funds for the Barts-MS Coronavirus Antibody Study.

This webinar will be delivered by Professor Gavin Giovannoni on Thursday 12th November 2020 from 17h30-18h30. The number of places is limited and will be allocated on a first-come basis. As a registrant, you are being asked to make a donation to support the Barts-MS COVID-19 Coronavirus MS Antibody study via our JustGiving page. The following is a short interview with main investigators explaining why this study is so important to people with MS.

CoI: multiple

#MSCOVID19: one microdonation at a time

Thank you for being such kind and generous supporters for our Barts-MS COVID-19 antibody study. It is clear that Prof G running the virtual NYC marathon this weekend, or next, depending on the weather, is not going to get us to the finish line. Therefore, we are going to take your advice and launch Barts-MS webinars. The webinar idea was suggested by one of you in the comments when we launched our fund-raising campaign.

There will be a limited number of places to watch these webinars, but to be allocated a ticket we are expecting viewer’s to make a microdonation towards our fundraising efforts so that Drs Ruth & Kang can start and complete our COVID-19 or coronavirus seroprevalence study.

At the end of the antibody study we should be able to answer some of the following questions:

  1. How many pwMS in the UK have antibodies to the SARS-CoV-2?
  2. What type of antibodies are they, i.e. IgM, IgG or IgA, what is the titre or level of these antibodies and are they neutralising? Neutralising means they inhibit coronavirus infection of cells in culture.
  3. How many pwMS seroconverted who had documented COVID-19, possible COVID-19 or no history of COVID-19?
  4. What is the seroconversion rate on different DMTs?
  5. We also hope to follow a group of pwMS longterm with repeat testing to see how long these antibodies last and to see how many seronegative pwMS convert to becoming seropositive with time.
  6. When a coronavirus vaccine or vaccines emerges we able to use the assay to see who makes an antibody response or not and hence we plan to compare different response rates on different DMTs.

The following are some suggestions for topics for the webinars:

  1. What are arguments for and against HSCT as a first-line treatment for MS?
  2. What is on the horizon for treatment of advanced MS?
  3. What will the management of MS look like in 2030?
  4. How can we make MS prevention a reality?
  5. What is smouldering MS and is it treatable?
  6. How are we managing MS during the COVID-19 pandemic?
  7. Will I be able to have a coronavirus vaccine when one arrives?
  8. Etc …..

These topics are not fixed in stone. If you have any suggestions let us know. Do you have any problems with us running these webinars? Would you be interested in attending? How do you feel about having to donate to attend the webinars?

For those of you interested the following is Prof G’s planned marathon route and if you want to make a micro-donation towards the study please click on the link below.

26.32 miles of bliss or hell

CoI: multiple

#MSCOVID19: digital health – what will survive?

Barts-MS rose-tinted-odometer: ★★★

I am doing a webinar with Professor Tjalf Ziemssen, a good friend and colleague from Dresden, Germany, this afternoon on the digital management of MS. Interestingly, many of the changes and innovations we have put in place to manage MS during the COVID-19 pandemic will survive and actually thrive in the new NHS, simply because we are a socialist healthcare system at the point of delivery. In comparison, in Germany, the reimbursement for digital consultations are an order of magnitude lower than old-fashioned face-2-face synchronous consultations. Therefore the adoption of digital tools to manage MS will be much slower due to the lack of financial incentives.

If you are interested in hearing about the differences between the UK and Germany please register and log-in today’s webinar.  

Please note this webinar will not be a didactic lectures, but more of a casual chat; banter between colleagues. I hope to see you later.

CoI: multiple

Twitter: @gavinGiovannoni  Medium: @gavin_24211

#MSCOVID19 webinar have you registered?

This week I am participating in a debate on how to manage patients with MS on DMTs during the COVID-19 pandemic. Rather than a didactic lecture, I am going to debate several issues with Dr Kerstin Hellwig in relation to two case scenarios (see below), which will highlight the evolving complexities of how to manage MS during these troubling times. If you haven’t registered yet please do so ASAP as places are limited.

Case 1: A 36-year old male has been on ocrelizumab for 2 years; this is his second DMT after having previously received interferon β-1a. He was due his 6th dose of ocrelizumab in March 2020 but this has been postponed indefinitely by his MS centre.

Do you agree with this decision?

What are his chances of getting severe COVID-19 with B-cell depletion?

What about secondary bacterial infections in the event he does get COVID-19?

When will it be safe to resume ocrelizumab treatment?

He is worried that on ocrelizumab therapy he will be unable to show response to an anti-SARS CoV-2 vaccine? Is this a factor to consider when reviewing his treatment?

Would you consider switching his treatment to allow him to be ‘vaccine-ready’ and if yes to what therapy would you switch?

Case 2: A 28-year old woman with highly active RRMS. Previously suffered relapses on dimethyl fumarate in the past. She was treated with oral cladribine in June and July 2019. She is due her second course in late June and July 2020. She had been told be her treating neurologist that she should delay her next course of treatment until after the COVID-19 pandemic is over.

Do you agree with this decision?

How effective is one course of oral cladribine and will it be sufficient to protect her during the current pandemic?

If she received her 2nd year of oral cladribine should she be shielded and for how long?

Could measuring her lymphocyte counts assist in management of this patients?

What is a safe lymphocyte count?

Would delaying her second course of oral cladribine affect her ability to be vaccinated with an anti-SARS-CoV-2 vaccine in the next 12-24 months?

East Africa and MS

COVID-19 impact has extended to East Africa. Instead of a face-to-face meeting, the East African Neurologists have moved their CPD (continuing professional development) online in the form or regular webinars. In the past, I would probably have had to travel to East Africa to give a guest lecture at their annual meeting. Post-COVID-19 I can now do this online, which is a much cheaper and greener option for the environment and much more time-efficient for all concerned.

The other advantage of webinars is that the CPD event doesn’t have to be geographically limited in that people can register and log-in from all over the world. This is taking the democratisation of knowledge and learning to the next level and is one of the reasons that motivated me to start triMS.online.

So if you are not from East Africa and you want to attend the webinar below please do not hesitate to register online and log-in tomorrow. Places are limited.

#MSCOVID19: Lymphopaenia

I am giving an MS Academy masterclass webinar today on the topic of lymphopaenia and its relevance to managing MS during the COVID-19 pandemic. My talk goes back to basics and tries to explain how the normal range and WHO grading system came about and includes the important topic of immunosenescence.

You are welcome to sign-up for the webinar. If you can’t manage to log-on to the live webinar it will be recorded and put on-line after the event.

The following are my slides for today’s webinar:

CoI: multiple

#COVIDMS Managing MS remotely during the COVID-19 pandemic

We had to postpone one of our MS Academy foundation courses this week due to the COVID-19 pandemic. In its place, we are doing a series of webinars. The first one was held yesterday morning with an overview of COVID-19 and how it is forcing us to be creative in managing MS over the next few weeks and months.

The following is my presentation and you can download the slides from my DIY-SlideShare site. I am aware that the MS Academy will be uploading the webinar to YouTube in the next few weeks.

I also spent yesterday designing and populating a #MSCOVID19 microsite written and a beta version is live. It is a work in progress, but over the next few days and weeks, it will become more comprehensive. I will be answering questions and presenting cases studies on the site. I have already had 20+ questions posted via the site and will work on getting these answered an online today.

CoI: multiple