Would switching from fingolimod to siponimod make any difference? What about all the other potential treatments for smouldering MS? What would you recommend?
Prof G, you say that you can't sanction the off-label prescribing of metformin, but metformin is part of the OCTOPUS/PLATYPUS trial. Are you saying it's not safe?
No but the OCTOPUS is a trial, i.e. a trial is different to off-label use. In a trial there is informed consent and protection for the treating physician. Outside of a trial there are no protections for prescribing physicians.
Prof G, you say that you can't sanction the off-label prescribing of metformin, but metformin is part of the OCTOPUS/PLATYPUS trial. Are you saying it's not safe?
No but the OCTOPUS is a trial, i.e. a trial is different to off-label use. In a trial there is informed consent and protection for the treating physician. Outside of a trial there are no protections for prescribing physicians.
Got it.
Just to mention that this patient is not eligible for simvastatin trial MS-STAT2 as requirements include:
1. diagnosis of SPMS min 2 years
2. no dmts (apart from siponimod)
In any case, recruitment closes tomorrow 31 August (web enquiries already taken down so would have to make quick contact direct with centre)
UK patients only.
Can you say what kind of dosage of alpha-lipoic acid would be suitable?
1200mg per day
Loy BD, Fling BW, Horak FB, Bourdette DN, Spain RI. Effects of lipoic acid on walking performance, gait, and balance in secondary progressive multiple sclerosis. Complement Ther Med. 2018 Dec;41:169-174. doi: 10.1016/j.ctim.2018.09.006. Epub 2018 Sep 22. PMID: 30477834; PMCID: PMC6263172.
Ah thank you