Rituximab vs Ocrelizumab for Relapsing Multiple Sclerosis?
A recent study compared two medicines used to treat relapsing multiple sclerosis (MS): rituximab and ocrelizumab. Both medicines work by reducing a type of immune cell called a B cell, which can contribute to MS inflammation and damage.
The study included people who had recently been diagnosed with active relapsing MS. After two years of treatment, the researchers found that rituximab worked about as well as ocrelizumab at preventing new areas of inflammation from appearing on brain MRI scans. There were also no major differences between the two treatments in terms of relapses, disability, or thinking and memory.
Infections were somewhat more common with rituximab, although serious side effects were similar between the two groups.
For patients, the important message is that rituximab appears to be a reasonable alternative to ocrelizumab for controlling active relapsing MS. Rituximab has also been used for MS for many years, although its use for MS is often "off-label," meaning it is not specifically licensed for MS in some countries.
The study therefore provides stronger evidence that rituximab can be an effective treatment option. However, treatment decisions should still consider individual circumstances, safety, availability, cost, and local licensing.
Is Thrombectomy Suitable For Large Strokes?
A recent study looked at whether thrombectomy, a procedure used to remove a blood clot from a blocked brain artery, can also help people who have already suffered a large area of brain damage from a stroke.
In the past, patients with a "large stroke" on their brain scan were often not considered suitable for thrombectomy, as it was thought that too much brain tissue had already been damaged. This study brought together the results of several recent clinical trials and found that this may no longer be the case.
The researchers found that patients with large areas of brain damage were more likely to have a better level of recovery if they received thrombectomy as well as standard medical treatment, compared with medical treatment alone. The benefit was seen across a range of patients and different ways of measuring the amount of brain damage.
This is important because it means that having a large area of stroke damage on the initial scan does not necessarily mean that thrombectomy will be futile.
However, thrombectomy is not suitable for everyone. Doctors still need to consider factors such as the location of the blockage, the amount of established brain damage, the patient's overall health and how long ago the stroke occurred. Overall, the study supports considering thrombectomy in a wider group of patients with severe strokes.
Blood Pressure Control After A Brain Haemorrhage?
A recent study looked at people who had previously suffered a brain haemorrhage, a type of stroke caused by bleeding in the brain. One of the most important ways of reducing the risk of another stroke is keeping blood pressure under good control.
The researchers tested a single tablet containing three different blood-pressure medicines, each at a low dose. The medicines were telmisartan, amlodipine and indapamide. They found that people taking the combination had lower blood pressure and were less likely to have another stroke than those receiving standard treatment alone.
Over about two and a half years, another stroke occurred in about 5 in every 100 people taking the three-drug tablet, compared with about 7 in every 100 receiving standard treatment. There were also fewer major cardiovascular problems in the combination-treatment group.
The treatment was generally well tolerated, although some people stopped taking it because of side effects, including changes in kidney function.
The study reinforces how important good blood-pressure control is after a brain haemorrhage. It also suggests that combining several medicines at low doses in one tablet may be an effective way of achieving better blood-pressure control and reducing the risk of another stroke.
How To Keep Your Brain Healthy As You Get Older?
This study looked at whether making several healthy lifestyle changes at the same time could help older people keep their memory and thinking skills in good shape.
The study included over 1,000 people aged 60–77 from several Latin American countries. The participants were at increased risk of problems with memory and thinking. One group joined a programme that encouraged them to exercise regularly, eat a healthier diet, keep their blood pressure and other health risks under control, do activities that challenge the brain, and stay socially active. The other group was given general advice about healthy living.
After two years, both groups showed some improvement in their memory and thinking, but the people taking part in the lifestyle programme improved more. The biggest benefit was seen in memory.
For patients, the main message is that there are practical things you can do to support your brain health. Looking after your body, staying physically active, eating well, keeping conditions such as high blood pressure under control, exercising your brain and maintaining social connections may all help.
Importantly, this study does not show that these changes prevent dementia. The researchers followed people for only two years and measured their thinking and memory, so longer studies are needed to find out whether these improvements can reduce the chance of developing dementia.
A Wearable Device to Reduce Hand Tremor?
Essential tremor is a common condition that causes shaking, usually in the hands. This can make everyday activities such as eating, drinking, writing, or using a phone difficult. Current treatments, including medications, do not work well for everyone and can sometimes cause unwanted side effects.
This study looked at a new approach: a small wearable device that uses gentle electrical stimulation on nerves in the arm. The device is designed to reduce the abnormal nerve signals involved in tremor. It also uses an artificial-intelligence system to adjust the stimulation automatically.
The study included 125 people with essential tremor. Participants were randomly given either the active device or a similar device that did not provide the therapeutic stimulation. After 90 days, people using the active device reported greater improvement in their ability to perform everyday activities than those using the inactive device.
However, the treatment was not completely free of side effects. About one-third of people using the active device developed some skin irritation, although this was generally manageable.
Overall, the results are encouraging because this offers a non-invasive treatment option that does not require surgery or medication. However, longer studies are still needed to understand how well it works over several years and which patients are most likely to benefit.
A New Once-Daily Treatment For Parkinson's Disease?
Parkinson's disease can cause symptoms such as shaking, stiffness and slowness of movement. Medicines that increase or mimic dopamine can improve these symptoms, but some commonly used treatments can cause problems such as sleepiness, dizziness, hallucinations or other side effects.
This study looked at a newer medicine called tavapadon, which is taken once a day. The researchers wanted to see whether it could improve movement in people who had been diagnosed with Parkinson's disease relatively recently.
The study included 529 people with early Parkinson's disease. They were randomly given either tavapadon at one of two doses, or an inactive placebo, for about six months. Neither the patients nor the researchers knew who was receiving which treatment during the main part of the study.
People taking tavapadon had meaningful improvements in movement and their ability to carry out everyday activities compared with those taking the placebo. Both doses appeared to work. The most common side effects were nausea, headache and dizziness, and most side effects were mild or moderate.
Overall, the results are encouraging. Tavapadon could become another treatment option for people with early Parkinson's disease. However, longer-term studies are still needed to understand its safety and effectiveness over several years.
Can Starting Lecanemab Early Help Slow Alzheimer's Disease?
Lecanemab is a newer treatment for people in the early stages of Alzheimer's disease. Unlike older medicines that mainly help with symptoms, lecanemab is designed to remove a protein called amyloid that builds up in the brain and is thought to contribute to Alzheimer's disease.
This study looked at people with early Alzheimer's disease who either did not carry, or carried one copy of, a particular gene called APOE ε4. The researchers found that people treated with lecanemab had a slower decline in their memory, thinking and ability to manage everyday activities compared with those who initially received placebo.
The researchers also followed people for up to three years. Those who started lecanemab earlier continued to do better than people who started treatment later. This suggests that starting treatment earlier may be more beneficial than waiting until the disease has progressed further.
However, lecanemab does not stop Alzheimer's disease or restore lost memory. It slows the rate of decline. Treatment also has risks, including brain swelling or small areas of bleeding that need to be monitored with MRI scans. Infusion reactions and headaches can also occur.
Overall, the study provides further evidence that lecanemab can slow Alzheimer's progression, particularly when treatment is started early.
Can We Break the Cycle of Migraine and Painkiller Overuse?
Some people with migraine develop headaches on 15 or more days each month and may end up taking painkillers or other migraine medicines very frequently. Unfortunately, using these medicines too often can itself contribute to more frequent headaches, creating a difficult cycle called medication-overuse headache.
This study looked at whether eptinezumab, a newer migraine-preventive treatment given through an intravenous infusion, could help people with both chronic migraine and medication overuse. Importantly, everyone in the study also received education about medication overuse.
The study included 608 adults from 76 specialist centres across 11 countries. After 12 weeks, people receiving eptinezumab had a greater reduction in migraine days than those receiving placebo. During the first four weeks, migraine days fell by about 7 days per month with eptinezumab compared with about 4 days with placebo.
Improvements were also seen in headache frequency, use of acute migraine medicines, pain and quality of life. Side effects were similar between the treatment and placebo groups, and no new safety concerns were identified.
The results suggest that we may not always need to wait for someone to completely stop overusing headache medication before starting effective migraine prevention. However, addressing medication overuse and educating patients remain important parts of treatment.
Which Epilepsy Medicine Works Best When Seizures Are Still Not Controlled?
For some people with epilepsy, seizures continue despite taking medication. Doctors then have to decide which additional medicine is most likely to control the seizures while causing the fewest side effects.
This study compared four commonly used medicines, cenobamate, brivaracetam, lacosamide and perampanel, in almost 2,000 adults with difficult-to-control focal epilepsy. The researchers combined information from 71 epilepsy centres and looked at how well the medicines worked after 6 and 12 months.
The results suggested that cenobamate was the most effective of the four medicines. More people taking cenobamate achieved at least a 50% reduction in their seizures, and more became completely seizure-free at both 6 and 12 months.
However, there was an important trade-off. Cenobamate also caused side effects more frequently than the other medicines studied. About 58% of people receiving it reported an adverse effect, compared with about 15% taking lacosamide.
The study therefore does not mean that cenobamate is automatically the best choice for every patient. Doctors need to consider seizure control alongside side effects, other medications, medical conditions and the individual patient's preferences. Overall, the study provides useful real-world evidence suggesting that cenobamate may offer particularly strong seizure control for people with drug-resistant focal epilepsy, but its higher rate of side effects needs to be considered.
Can One MS Treatment Keep The Disease Quiet For 5 Years?
Multiple sclerosis (MS) is a condition in which the immune system attacks the nervous system, causing episodes of symptoms such as weakness, numbness, vision problems and difficulties with balance. Modern treatments can reduce these attacks, but an important question is whether they continue to work safely over many years.
This study followed people with relapsing MS who had taken ublituximab, a treatment that targets B cells involved in the immune response. The researchers looked at outcomes over five years using data from the ULTIMATE I and II trials.
Among people who continued ublituximab, the number of relapses remained very low. By the fifth year, there was approximately one relapse for every 50 patient-years of treatment. About 92% of people who had started ublituximab from the beginning remained free from confirmed worsening of disability. People who switched from another MS treatment, teriflunomide, to ublituximab also experienced a substantial reduction in relapse rates.
The researchers did not identify any new major safety concerns with longer-term treatment. Serious infections remained relatively uncommon, although infections and infusion reactions are important potential side effects of this type of treatment.
Overall, the study provides reassuring evidence that ublituximab can continue to suppress MS activity over five years. It also supports the broader idea of starting an effective MS treatment early rather than waiting for repeated relapses or disability to develop.
If any of these conditions are relevant to you or someone you care for, Dr. Yap Siew Mei is available for consultation at Kempas Medical Centre and Pulai Springs Healthcare Centre in Johor Bahru.
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