Q&A-6 for paying subscribers

Does alemtuzumab increase my risk of cancer and does it interact with HRT? Ocrelizumab or natalizumab post-siponimod; which would you recommend? Can I take creatine supplements with my DMT?

Questions

Q1: I am concerned about the cancer risks associated with alemtuzumab (Lemtrada); does it synergise with hormone replacement therapy (HRT) to increase my risk of getting breast cancer?

Q2: I am a 55-year-old woman with SPMS and have had no treatment since December 2022, when my neurologist stopped siponimod (Mayzent) treatment because of lymphopenia. At that stage, I was only on a 1/4 dose. Since stopping, I have been deteriorating rapidly. Now I can hardly walk, and I am having cognitive difficulties. I have been offered ocrelizumab (Ocrevus) or natalizumab (Tysabri). I am wondering whether I should have stayed on siponimod (Mayzent) even at a 1/4 dose, or should I rather start or ocrelizumab or natalizumab?

Q3: My personal trainer suggests taking creatine supplements and whey protein to help improve my muscle strength. I note the summary of product characteristic states under liver conditions: “While creatine itself is not known to have a significant impact on liver function if you have liver problems or are taking medications that affect the liver, it's essential to consult with a healthcare professional before using creatine”. I have been treated with alemtuzumab; is it safe to take creatine? Will it help my MS?  

NOTE: General substack newsletters and microsite are free; only Q&A sessions 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 us (ms-selfie@giovannoni.net) to request a complimentary subscription.

Answers