Q&A-2 session for paid subscribers

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Q&A-2 session for paid subscribers

Siponimod or not? To start a DMT or wait? T-cell and B-cell repopulation post-HSCT?

Q1: Siponimod or not?

I’m 62 and was diagnosed with MS at about 40. I stopped Gilenya in 2016 due to a very high gamma-glutamyl transferase or GGT (no alcohol intake) with gut problems. My GGT was back to normal within four months. I have been offered siponimod (Mayzent) but decided against it because it is very similar to fingolimod. So, I am currently not on any treatments. I have been told I am NEIDA, although one neurologist said that some lesions had increased in size. 

I’m now diagnosed with SPMS. I manage my health with physiotherapy and lifestyle adaptions. I have bowel and bladder problems and physical disabilities, i.e., unsteady gait, weakness in my legs, vertigo and cluster head pains for which I have nerve blocks. My question is, would you suggest siponimod or not at this stage?

Q2 - To start a DMT or wait?

I had a lesion on my spine four years ago, and a brain scan revealed a lesion there, too. Repeat MRI has found no new lesions after four years. My neurologist suggested that I not go on to a DMT at this stage as they believe my MS to be mild, and he did not feel the risks of going on a DMT were warranted. He advised that DMTs help to prevent new lesions but don't prevent smouldering MS. 

Am I missing an opportunity to manage MS proactively at an early stage? 

Q3: T-cell and B-cell repopulation post-HSCT?

My T cells have repopulated in just four months after HSCT. They took over 1.5 years on alemtuzumab (Lemtrada), and I subsequently failed alemtuzumab. 

Am I correct that I will likely relapse once my B-cells have repopulated? 

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