Excellent summary OHM20.
There is some corroborative data in studies looking at delta32 mutations although you have to be cautious in reading some of the older studies with mixed to contradictory conclusions.
https://www.sciencedirect.com/science/article...5918301393
The clinical trajectory for multiple sclerosis is ultimately a scenario involving loss of function so early and effective treatment is important. Some of the disease modifying treatments are rife with adverse events up to and including death. Here it is important to stress that Leronlimab won the SAE lottery…there is always going to be an easy “risk vs benefit” discussion when Leronlimab is on the table. Here is a review of DMT’s for the different types of MS; a casual glance emphasizes there is commonly a harder discussion when many of the DMT’s are under consideration. This is especially true in the early stages where the patient may be feeling fine but the clinician knows you want them to continue feeling fine and hence have to lead with a DMT that patients may come to regret as it pushed them into not feeling so fine due to side effects.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC...ne%20drugs.
“Disease-modifying therapies for multiple sclerosis (MS) modulate or suppress with different mechanisms the autoimmune process that underlies the disease. Patients with relapsing MS may benefit from treatment but individual response to a given therapy and adverse events occurrence are largely unpredictable and many cases need to change several drugs to stabilize their disease. Nevertheless, a high proportion of patients evolve to a progressive phase, which is not responsive to any existing therapy.”
There is some corroborative data in studies looking at delta32 mutations although you have to be cautious in reading some of the older studies with mixed to contradictory conclusions.
https://www.sciencedirect.com/science/article...5918301393
The clinical trajectory for multiple sclerosis is ultimately a scenario involving loss of function so early and effective treatment is important. Some of the disease modifying treatments are rife with adverse events up to and including death. Here it is important to stress that Leronlimab won the SAE lottery…there is always going to be an easy “risk vs benefit” discussion when Leronlimab is on the table. Here is a review of DMT’s for the different types of MS; a casual glance emphasizes there is commonly a harder discussion when many of the DMT’s are under consideration. This is especially true in the early stages where the patient may be feeling fine but the clinician knows you want them to continue feeling fine and hence have to lead with a DMT that patients may come to regret as it pushed them into not feeling so fine due to side effects.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC...ne%20drugs.
“Disease-modifying therapies for multiple sclerosis (MS) modulate or suppress with different mechanisms the autoimmune process that underlies the disease. Patients with relapsing MS may benefit from treatment but individual response to a given therapy and adverse events occurrence are largely unpredictable and many cases need to change several drugs to stabilize their disease. Nevertheless, a high proportion of patients evolve to a progressive phase, which is not responsive to any existing therapy.”
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