Quote:
Originally Posted by Lady
BBS I think he said that he thought immunosuppression, in the early stages of MS, was the way to treat. Before damage is done and could not be regained.
He said not think the DMD's should be the first line of treatment, that is why it contradicts all the previous opinions.
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Funny how he just left that thought hanging out there without clarifying it. I read it a little differently. Here's his quote:
Quote:
Given that the only
process that we can identify right now
is an inflammatory process—if we want
to change the outcome, we need to shut
off that inflammatory process early. And
that’s not what we do—we only suppress
it slightly, and over the long term that
has not resulted in a major change in
outcomes for patients. Clinicians are
treating patients in the clinic based on
what they look like right now. They
only use aggressive treatment when
patients are clearly failing with the firstline
therapies and accumulating more
disability.
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emphasis added by me
First line therapies would be the ABCR drugs... this is typically what neurologists suggest, and brush over the aggressive options like Tysabri and Novantrone unless a patient has utterly failed the other ones.
He then goes on to say:
Quote:
The model we are trying to
promote now says: don’t wait for them
to develop disability. Use the MRI to
determine how active they are and be
willing to take the risks upfront, before
they get disability, by selecting patients
based on what’s happening to their
brains, particularly in terms of TI black
holes and ventricular size.
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I think this is the key bit that makes it seem like he's saying that patients that are at increased risk for greater disability should be pushed to the more aggressive drugs earlier in the disease, rather than waiting until they get disabled before pulling Tysabri and Novantrone out of the hat.
I think it makes a great deal of sense, personally. Which is why I'm giving Copaxone and LDN a shot but if I start declining and relapsing severely on those I'm skipping the interferons and looking at the venous occlusion/stent placement and then Tysabri if needed. I'm not willing to meddle around with the other stuff when there's a stronger more effective treatment available. That's how I personally understood his point, maybe that's just my own bias reading into it though.