Natalizumab for optic neuromyelitis optica Natalizumab is a humanized monoclonal antibody that binds specifically to the alpha chain of integrins to block the receptors of inflammatory immune cells from binding to them, thereby blocking the autoimmune response caused by immunoreactive cells “escaping” outside the blood vessels and entering tissues and organs (e.g., in the brain), and ultimately achieving prevention and treatment of disease. Clinically, natalizumab is mainly used in the treatment of multiple sclerosis and segmental enteritis. A year ago, German scholars published a short paper in which they screened five patients who were suspected of having relapsing-remitting multiple sclerosis from those who were treated with natalizumab, and then confirmed the presence of antibodies to aquaporin-4 by blood tests, with a revised diagnosis of optic neuromyelitis optica. All five patients were female and were treated with escalating natalizumab after failure of first- or second-line immunomodulatory therapy. Results: The 5 patients received an average of 8 infusions of natalizumab, but showed persistent disease activity and 9 relapses after initiation of treatment. 4 patients had increased disability and 1 patient died after termination of treatment. The authors concluded, based on their own observations, that natalizumab did not control the disease activity of optic neuromyelitis optica. Subsequently, another Australian scholar reported a case of myelitis in which the disease continued to be active despite treatment with natalizumab. Note: With the development of science and technology, there are more and more biological agents, which are more specific and have fewer adverse effects than chemical drugs. However, it is because they are “too specific” that they show limitations. Because the same clinical manifestations such as optic neuromyelitis optica and multiple sclerosis, both involving the optic nerve and spinal cord, including the brain, have different pathogenesis and different response to treatment. Since the response to treatment may be different for different individuals with the same disease, it is not possible to make analogies. In other words, biological agents used to treat multiple sclerosis may not be suitable for treating optic neuromyelitis optica. A few years ago, there were reports of patients with optic neuromyelitis optica getting worse during the use of interferon, and we have seen similar patients. So, before using a “new drug”, be sure to weigh the pros and cons, not only for your wallet, but also for your body. Oral versus intravenous hormone therapy for multiple sclerosis relapses Recently, Canadian scholars reviewed research papers between 2008 and 2012 on the role of hormone use in the treatment of acute multiple sclerosis relapses, in which the subjects should be within 6 weeks of the acute relapse Q and 16 years of age. A total of five clinical trials comparing oral and intravenous hormone use were collected and by comparing clinical benefits and adverse effects, MRI lesion changes, and drug treatment outcomes, the authors found no statistically significant differences between the two treatment methods. This leads to the conclusion that oral hormones should be a clinically practical and effective treatment in the treatment of acute exacerbations of multiple sclerosis in addition to the intravenous route. in 2009, this group of authors previously published a similar paper meta-analysis with the same conclusions. Note: To date, hormones remain the drug of choice for relapses in a variety of autoimmune diseases. Should they be taken orally? Or intravenous? Not only are patients torn, but so are physicians. Patients are not necessarily doctors, they are not necessarily close to hospitals, and intravenous use is indeed inconvenient, while oral use is extremely convenient. However, in terms of the mechanism of drug therapy, intravenous use of drugs can reach a peak in a short period of time, which is conducive to the induction of immune apoptosis, rapid reduction of tissue edema, which is the main theoretical basis for the creation of “shock therapy”. In my opinion, if the relapse is mild and it is not convenient to use intravenous access, oral hormones should be used; when available, the intravenous route should be chosen. Vitamin A and the risk of multiple sclerosis In the latest issue of the Journal of Multiple Sclerosis, a prospective study by Swedish scholars will be published, in which they measured vitamin A in the serum of multiple sclerosis patients and healthy controls, as well as C-reactive protein (a biomarker of inflammation in the body), in order to demonstrate the relationship with the risk of multiple sclerosis. It was concluded that an insufficient level of vitamin A in the body may be accompanied by a risk of developing multiple sclerosis. However, if a pregnant woman has a deficiency of vitamin A in her body, there is no effect on her offspring. Elevated concentrations of C-reactive protein in the body also increase the risk of developing multiple sclerosis. Note: It is widely recognized that vitamin D is a protective factor for multiple sclerosis, and now it is proposed that vitamin A is also a protective factor for multiple sclerosis. We should pay attention to the appropriate amount of supplementation, but do not overdose ah, is a medicine three points of poison!