Q&A-5 for paid subscribers

When to flip the pyramid? What new MS therapies are interesting? Brain volume loss in clinical practice?

Questions

Q1: When you are newly diagnosed - why start off, unless because of personal choice, with a therapy which is not as effective?  Why not start off with the best DMT to stop the disease from potentially progressing?

Q2: What are the most promising new treatments in development for MS? Will it be the new T-cell therapy that has been used on lupus? Or would cladribine, BTK inhibitors, or frexalimab make a difference?

Q3: Why is brain volume not routinely measured in clinical practice, and why do neurologists ignore it as an outcome measure when comparing DMTs? 

NOTE: General substack newsletters and microsite are free; it is only Q&A sessions that are restricted to paying subscribers. I can't run and maintain the MS-Selfie microsite, hence the need to pay people to help do the work for me. If people want to ask medical questions unrelated to the Newsletters or Podcasts, they either need to become paying subscribers or email (ms-selfie@giovannoni.net) to request a complimentary subscription.

Answers