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1 week ago | 
gavingiovannoni.substack.com | Gavin Giovannoni
Dear Professor Giovannoni, I live in Scotland and am considering having an autologous haemopoietic stem cell transplant (AHSCT) done privately in London. Do you think it is reasonable to take up this option? What do you think of the recent results of AHSCT just published? I am pretty concerned that the death rate from the procedure is higher than I expected. Thank you. NOTE: General Substack newsletters and the microsite are free; only Q&A sessions are restricted to paying subscribers.
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2 weeks ago | 
gavingiovannoni.substack.com | Gavin Giovannoni
I am 38 38-year-old woman with relapsing-remitting multiple sclerosis. Earlier this year, I was switched from fingolimod (Gilenya) to cladribine (Mavenclad) due to an HPV infection and abnormal cervical smear. I had stopped fingolimod and was started on cladribine slightly more than 6 weeks after my last dose of fingolimod. My lymphocyte count was 473 on fingolimod, which recovered to 1.47 the week before I started cladribine.
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2 weeks ago | 
gavingiovannoni.substack.com | Gavin Giovannoni
I was invited to speak at a Type 1 Diabetes Mellitus (T1DM) meeting in Birmingham. The meeting focused on the early disease detection for potential secondary prevention. You can download the programme here. The T1DM field thinks the field of MS has something to teach them about disease modification and prevention. I believe the contrary, i.e. we have a lot in the field of MS to learn from them.
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2 weeks ago | 
gavingiovannoni.substack.com | Gavin Giovannoni
Dear Prime MinisterThe NHS is in crisis. Labour’s and Wes Streeting’s policies on the NHS make little sense and will make things worse. The UK needs to look at other healthcare systems for inspiration. Adopting a sledgehammer or chainsaw to cut costs and drive efficiencies in the NHS will not work. For example, cutting costs by reducing the number of NHS managers to improve productivity will fail. The NHS is one of the most undermanaged healthcare systems in the world.
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3 weeks ago | 
gavingiovannoni.substack.com | Gavin Giovannoni
As promised, my presentation from the Nobel Symposium can be viewed here, and I have recorded my lecture so you can listen to it. I hope this generates a lot of interest and discussion. NOBEL SYMPOSIUM - Multiple Sclerosis: From Molecular Mechanisms to Disease-Modifying Treatments. 2-5 June 2025 | Nobel Forum | Stockholm, Sweden. ThanksMS-Selfie newsletters and access to the MS-Selfie microsite are free. In comparison, weekly off-topic Q&A sessions are restricted to paying subscribers.
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4 weeks ago | 
gavingiovannoni.substack.com | Gavin Giovannoni
I always stress the importance of derisking disease-modifying therapies as best you can before starting treatment. For example, we try to insist that patients have an up-to-date cervical smear or vaginal human papillomavirus (HPV) PCR to exclude active HPV infection before starting alemtuzumab. In reality, we should be doing this with all chronic immunosuppressive therapies, particularly the S1P modulators (fingolimod, siponimod, ozanimod, ponesimod).
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1 month ago | 
gavingiovannoni.substack.com | Gavin Giovannoni
I am 42 years of age and have been on ofatumumab for 14 months. Before this, I had been treated with ocrelizumab (Ocrevus) and before this, dimethyl fumarate (Tecfidera). I was switched from ocrelizumab to ofatumumab because of mild persistent lymphopaenia. My lymphocyte counts were around 0.7 to 0.9. My counts have recovered on ofatumumab and now run at 1.1 to 1.2. However, over the last 12 months, my MS fatigue has gotten a lot worse.
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1 month ago | 
gavingiovannoni.substack.com | Gavin Giovannoni
I am 35 years old and have relapsing MS. I have been stable on ocrelizumab for the last three and a half years. I have just developed shingles, which is a very unpleasant rash across the left side of my chest onto my breast. I have an intense burning and prickling sensation where the rash is. Is shingles a common complication of ocrelizumab treatment? My pharmacist has given me acyclovir. Is this appropriate? Why wasn’t I offered the Shingrix vaccine before I started ocrelizumab?
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1 month ago | 
gavingiovannoni.substack.com | Gavin Giovannoni
I suffered what I now know was optic neuritis in my left eye in 2010. I buried my head in the sand somewhat as I feared I had MS (my mum was diagnosed with SPMS when I was 8 years old), and I chose not to see a neurologist – I suppose I did not want to face reality at that time. I recovered from the optic neuritis after about 3 weeks and had no further relapses, but suffered a lot from invisible sensory symptoms (mainly tingling in both legs) over the years.
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1 month ago | 
gavingiovannoni.substack.com | Gavin Giovannoni
You may already know Dominic Shadbolt. Dominic started and runs the YouTube channel The MSGuide for people with MS. Dominic is a big proponent of lifestyle optimisation to manage MS. Last year, we came up with the crazy idea of him raising money for MS Brain Health initiatives by riding across Canada. He has set himself the ambitious challenge of raising $1 million to support global MS Brain Health initiatives. Despite my trying to talk him down, he seems determined to ride across Canada.