CD20

It does not make the indication to treat or not to treat.

However, when you treat, we do know that for the high-risk cases, the second generation anti-CD20 antibody, Obinutuzumab, does have some benefit for progression-free survival, which is not the case for the low-risk patients.

So this is, therefore, there is really a differential treatment or at least consideration of these different risk groups, so therefore this guides our treatment, but it does not guide the indication to treat.

I would

Well, it's important to acknowledge these are European guidelines and there are different flavors in the different countries how to approach this kind of disease.

As a general theme, we tend to start smoothly because we have a second chance.

Having said that, in most European countries, standard of care is a combination of a specific treatment, anti-CD20 agent, plus chemotherapy.

And by targeting the malignant disease from different sites, you can really achieve long-term remission.

She was diagnosed with MS within a few months of clinical initial presentation.

At the beginning, she was started on a first line oral therapy and did okay on it for the first five years, but then had clinical disease breakthrough and was started on an anti-CD20 agent six years ago.

and has had both clinical and MRI disease stability with respect to having no relapses and her MRIs have been completely stable.

She has a pretty intense job.

We scan her again.

Her MRI of the brain and cervical and thoracic spinal cord is stable, so no new lesions.

And she's been continuing the anti-CD20 agent dutifully without missing any doses.

So I'd like to ask you to pause for a moment to reflect.

She was diagnosed with MS within a few months of clinical initial presentation.

At the beginning, she was started on a first-line oral therapy and did okay on it for the first five years, but then had clinical disease breakthrough and was started on an anti-CD20 agent six years ago.

and has had both clinical and MRI disease stability with respect to having no relapses and her MRIs have been completely stable.

She has a pretty intense job.

We scan her again.

Her MRI of the brain and cervical and thoracic spinal cord is stable, so no new lesions.

And she's been continuing the anti-CD20 agent dutifully without missing any doses.

So I'd like to ask you to pause for a moment to reflect.

So, I mean, I think given the options that were available when the patient started, like completely reasonable, I will throw in a word of caution about autoimmune cytopenias.

So when you have a patient who has rip-wiring autoimmune hemolytic anemia or ITP symptoms, obviously the CD20 part of this, the obinutuzumab is likely to help.

Sometimes venetoclax can actually worsen those autoimmune processes.

So it's worth just watching very carefully as you're starting venetoclax to make sure you don't kind of have resurgence of autoimmune cytopenias as you're starting.

So, I mean, I think given the options that were available when the patient started, like completely reasonable, I will throw in a word of caution about autoimmune cytopenias.

So when you have a patient who has rip worrying autoimmune hemolytic anemia or ITP, obviously the CD20 part of this, the obinutuzumab is likely to help.

Sometimes venetoclax can actually worsen those autoimmune processes.

So it's worth just watching very carefully as you're starting venetoclax to make sure you don't kind of have resurgence of autoimmune cytopenias as you're starting.

And then the other one is Epkinley, which is co-commercialized with AVI.

It's a CD3, CD20 antibody in B-cell malignancies.

So this one is a big one because we just had our first readout in frontline if you search B-cell where we had a really historical little precedent hazard ratio of 0.49 that was just released in the public domain, which basically means it's the most positive phase 3 Essentially, since these things have been documented, without a doubt, certainly a landmark study going all the way back to 2002.

And then we have this now second anchor of drugs that we fully own, where there's no one else involved.

So, I mean, I think given the options that were available when the patient started, like completely reasonable, I will throw in a word of caution about autoimmune cytopenias.

So when you have a patient who has rip worrying autoimmune hemolytic anemia or ITP, obviously the CD20 part of this, the obinutuzumab is likely to help.

Sometimes venetoclax can actually worsen those autoimmune processes.

So it's worth just watching very carefully as you're starting venetoclax to make sure you don't kind of have resurgence of autoimmune cytopenias as you're starting.