Bruton's Tyrosine Kinase Inhibitors for Multiple Sclerosis Explained by Neurologist
Vložit
- čas přidán 27. 06. 2023
- Is it hype or hope? The Bruton's tyrosine kinase inhibitors have been purported to benefit "smouldering" multiple sclerosis. In this video, I explain how drugs like masitinib, tolebrutinib, evobrutinib, and fenebrutinib work. We review the side effects and data from clinical trials.
2012 masitinib progressive MS pilot study: bmcneurol.biomedcentral.com/a...
Review of emerging MS therapeutics: www.ncbi.nlm.nih.gov/pmc/arti...
The role of mast cells on the blood brain barrier: pubmed.ncbi.nlm.nih.gov/26004...
AB science press release of the phase 2B/3 study on masitinib in progressive MS: www.globenewswire.com/news-re...
Article on the masitinib from the Barts MS blog: multiple-sclerosis-research.o...
Abstract from Dr. Vermersch about the phase II trial: cslide.ctimeetingtech.com/msd...
MS news today article on masitinib: multiplesclerosisnewstoday.co...
Product label of MASIVET: www.ema.europa.eu/en/document...
Tyrosine Kinase Pathway: www.researchgate.net/figure/S...
A diagram showing the potential role of Bruton’s Tyrosine Kinase inhibiting drugs (tolebrutinib, evobrutinib, masitinib) in Multiple Sclerosis: link.springer.com/article/10....
Evobrutinib Efficacy is Maintained Over Two Years in an Open-label Phase II Study Extension in Patients with Relapsing Multiple Sclerosis (4124): n.neurology.org/content/96/15...
lacebo-Controlled Trial of an Oral BTK Inhibitor in Multiple Sclerosis: www.nejm.org/doi/full/10.1056...
Safety and efficacy of tolebrutinib, an oral brain-penetrant BTK inhibitor, in relapsing multiple sclerosis: a phase 2b, randomised, double-blind, placebo-controlled trial: www.thelancet.com/journals/la...
Comment or ask questions below! I would be happy to answer!
Subscribe on CZcams for more videos every Wednesday!
Make video requests in the comments section!
Check out my book “Resilience in the Face of Multiple Sclerosis” FREE on Amazon: amazon.com/dp/B07WP7H5LK It's about 5 people with MS who live incredible lives, the science and psychology of resilience, mindfulness, and ho’oponopono. Paperback priced to generate $0 royalty.
Dr. Brandon Beaber is a board-certified neurologist with subspecialty training in multiple sclerosis and other immunological diseases of the nervous system. He is a partner in the Southern California Permanente Medical Group and practices in Downey, California (South Los Angeles). He has several publications on MS epidemiology and has participated in clinical trials for MS therapeutics. You can follow him on twitter @Brandon_Beaber where he regularly posts about MS news and research.
Follow me on twitter: / brandon_beaber
Music: INNER GRACE - Copyright 2018 Wilton Vought Source: Really Really Free Music Link: • Video T
he video material by Dr. Brandon Beaber is general educational material on health conditions and is not intended to be used by viewers to diagnose or treat any individual's medical condition. Specifically, this material is not a substitute for individualized diagnostic and treatment advice by a qualified medical/health practitioner, licensed in your jurisdiction, who has access to the relevant information available from diagnostic testing, medical interviews, and a physical examination. To the extent that Dr. Beaber endorses any lifestyle change, behavioral intervention, or supplements, the viewer should consult with a qualified healthcare professional to determine the safety and efficacy of the intervention in light of their individualized information. - Věda a technologie
Very nice video. We're actively involved in several of these trials at present.
I have been following you both with optimism for our future. Thanks for your dedication!
Nice. I have a few patients in the PERSEUS trial.
Both of you are gifts from God. Thank you from a random guy from Florida.
Ocrevus was poison for me personally hindsight
No,HSCT USA way behind old as Bidenomics Cayman Islands safer more effective & way less disability discrimination more than anybody since Fox(x) In Living Color& JohnQ movie reality sadly
I was part of the evolutionRMS2 study. Evobrutinib vs Aubagio. The center that I was at was absolutely horrible about listening to side effects, and I left for my own safety. I hope others have a better experience in trials. I absolutely recommend doing things for science, but remember that you're your best advocate!
It a very beautiful thing to see myself healthy again after using remedy from Dr Ake on CZcams, I finally got cured of my Multiple Sclerosis with his herbs med and I can tell how great my health has turned out so far.
Thank you 🙏 ❤️🫣💕
I am involved in Gemini I and II. Glad to hear about this topic, thanks for the video. I have been in the trial for 1,5 years, haven't had any relapses since then and since my diagnosis. I was diagnosed two years ago, in my country you can get medicine if you have at least 2 flair ups, so I was happy I could begin taking trial medicine.
Thank you for doing the trial! I was in the Evobrutinib vs Aubagio EVOLUTIONRMS2 trial.
Thank you Dr Beaber for this high quality information! It's wonderful to have someone who updates us on new information. Also wonderful to go to our Dr. appointments so well informed.
Great content as always Dr. Beaber. If my MS transitions to the progressive form with no active relapse/lesions I would like to try BTK inhibitors. Hopefully they will show better efficacy against progression than other DMTs✌🏼
Science will save us. Thanks Dr. Beaber. B cell depletors made a great success. As I see Bruton's Tyrosine Kinase Inhibitors have the potential for another breakthrough. Can't wait for more phase 3 trials.
It a very beautiful thing to see myself healthy again after using remedy from Dr Ake on CZcams, I finally got cured of my Multiple Sclerosis with his herbs med and I can tell how great my health has turned out so far.
Thank you 🙏 ❤️🫣💕
Thanks Dr Beaber, one of the best video reviews of BTKi I've seen so far.
:)
I have been fortunate to study with in my field (music) with some world class innovators. They not only passed on knowledge and skills, but also more inspired me and in a sense made me smarter or more spongelike/receptive and thirstier for knowledge.
The realities of the universe are limitless and the status quo and existing arsenal at any time must be constantly be re-born and re-discovered. If a music creator is in the zone ANY moment offers new possibilities the well never runs dry. It should be no different in other fields.
Thank you good Dr. Brandon Beaber for delivering this and other videos which explain, the gist , the details, the caveats & confounders, help us (MSers) be inspired more spongelike students.
The being hopeful part is ultimately in our personal domain and so, your lack of affectation (though u r passionate and fearless) is appropriate I think for many of us fighting MS whoin the end need to have a positive psychological visualization in bettering our health through the intangible faith like x-factor (whether we are Darwinians, or scripturists or whatever stripe).
My HSCT at Ruiz happens this Sept 2023 in Puebla. I didn't have slowed progression on B cell depletion. I'm 59 with PPMS, and this HSCT is not a slam-dunk but I've heard from many (even those with PPMS some even older than me) who have had their progression halted. I'm still with out cane and performing music live and in the studios but progression is not halting, so endless thanks for this and all your work.
Thanks for the video! Has me excited! I have also heard about imu-838 being in late stage trials and showing protection against smoldering. Would love a video about it! Thanks again!
Thanks for the suggestion
Currently part of the fenebrutinib study! This video really helped me understand it even better ❤
great!
So how is It ?
Hey Doc!
Thank you for the great content as always!
I was diagnosed with probable MS after my first attack of ascending numbness up to right around my chest + positive Lhermitte’s. MRI showed 12-14 small lesions in the brain ( some enhancing ) and one lesion in the cervical spine. After 1 week of Solumedrol, my CSF came back positive for Lyme (elisa) and they started me on Ceftriaxone for 3 weeks. Everything resolved within 2 months except a bit of Lhermitte’s and internal tremors after running/walking.
3 years fastforward, I had another attack - exact same symptoms but this time I took no medication and it resolved within 3 months . (No change in my MRI of head and cervix)
My neuro prescribed hypothalamus phospholipids alongside high dose B1+6+12 shots for 10 days due to my reluctance to start on DMDs.
I understand you cannot provide medical advice but any comments/thoughts would be highly appreciated! I am 26 male and very worried for my health!
Please, let me know if you provide paid online consultations! I would so love for you to be my neuro! I live in Azerbaijan and we have no MS specialists here.
I can only see patients within my organization (kaiser permanente southern california permanente medical group). I wish you the best of luck.
Thanks for the great explanation! I’m hoping for the best for BTK inhibitors. I’m one of those older people who needs something besides an immune suppressor DMT.
Thank you so much sir !! You are a wonderful person bless your soul, may your days be always prosperous and healthy
Thanks
Thanks so much Dr. Beaber. It is so encouraging that there may be another option soon for people with MS. Could you do a video explaining the difference between smoldering MS (PIRA) and SPMS & PPMS?
PIRA is strongly associated with progressive disability in SPMS and PPMS. Here is a video on PIRA: czcams.com/video/duwSGmbHa0E/video.html In my opinion, SPMS and PPMS are the same disease as explained here: czcams.com/video/OboOmXJUdcs/video.html
In rrms PIRA is just hidden by brain reserve...once reserve is gone you have
spms and ppms appear. But is just same disease process with no reserve.
hsct is only thing...see "normal brain atrophy after hsct for ms"
btki is a dream...see "biogen bails on btk"
Excellent video thank you Dr Beaber!
Thanks
Any new updates on the stemcell transplant trials? I applied for the one in San Diego and am waiting for the next step after Dr Burt requested my actual MRIs to review.
My ms neuro said in the most recent journal that the results are coming in to be not much better than the big gun DMTs what are your thoughts?
Love these kind of videos! Ive been rooting for DKT. The Primary progressive warriors really NEED help!!
THANK YOU!!
Doctor Beaber you are true professional. Thank you for all this info.
Thanks
Good and informative video as always! 🙏 I have been on a clinical trial Evobrutinib against Tecfidera for nearly 2 years 2017-2019, no major side effects, maybe some bloating if I recall correctly, but I got one nasty relapse in that period. The good thing was that on MRI one of my lesions had disappeared.
Were you later unblinded? Do you knew which agent you received?
@@DrBrandonBeaberYes, I was on Evobrutinib twice daily and I'm pretty sure the dose was 75mg.
@@borqnabogomilova1449That's interesting! I wondered if different dosages were given in different trials. I ended up finding out I took Evobrutinib 45mg twice a day.
Thank you for this information! I wasn't able to join a BTKi trial because my lymphocyte count was just under the requirement after 9 years on Gilenya. I've had MS for 24 years and I'm looking forward to BTKi or other therapies that will target smoldering MS. I'd love to learn more about how infections may activate MS and induce activity. Last year after a mild case of COVID-19, my MRI showed an enhancing lesion for the first time in more than 12 years, though I wasn't having specific symptoms of a relapse.
I just filmed a video on human endogenous retroviruses and MS to be published in 3-4 weeks.
I am 55 and was recently diagnosed with RRMS. My neurologist suggested I participate in a Phase 3 BTKi study. Quite naturally I was stunned to hear the diagnosis so I had to give it some thought. I was overwhelmed and had a few days to decide. So I decided to take Kesimpta. Only time will tell if I will regret my decision.
How did the DMT work for ya jc thanks 🙏
Thanks doc. Very interesting and informative, though some of the science does go over my head. Do all the BTKIs put lots of pressure on the liver? I was turned away from one phase I/II trial because I take another med for a diff disease that leaves the body via the liver and occasionally causes secondary bother. They seem to be 'where it's at' for pharma at the moment and I would hope one day to give them a go.
Thanks for another great video - I'm currently on Ocrevus (10 months in) and it's working well so far without any significant side effects. I'm very happy to continue on it. However, I'd consider switching to a BTKI because of the long term risks of immunosuppression. I'm hoping the longer term data shows promise.
In your opinion, do you think patients on b-cell depleaters would have an easy transition to a BTKI based on their modes of action? I had a very easy switch from Tysabri to Ocrevus with no side effects or relapses.
The switch from Tysabri to b-cell depleters is very well-studied. There may be some risk in starting a BTK inhibitor while the b-cells are still depleted. We would probably find out through observational studies, and some doctors will probably advise waiting until there is some repletion of b-lymphocytes at first.
The term "smoulering MS" is a great way to describe MS in people that have had MS for a long period of time.
Hello
Many thanks for your brillant vidéos, very much appreciated.
As a subject for future videos could I suggest something on Exo squeleton to improve walking?
I know this is a borderline subject not fully depending on médical researches but involving commercial content.
I could understand the answer could be not my domain of expertise but just trying if there is anything you could bring on this subject.
Once again very good job done on this Channel!
Great video! You have explained the BTKI's better than any other I have heard. Thank you so much for taking time to do these videos for us. God Bless you ❤
I'm glad you liked it
Hi Dr. Beaber - Good Video - Realistical when would be the earliest date the BTK inhibitors could be approved? Best Regards
There's a study trying to "flush" microglia and stop smoldering MS with high dose rituximab.many studies where presented in the last AAN.
I am following these drugs with an optimism I haven't felt for other DMTs. Yes I would participate in a trial. I'm checking to see if Oregon Health and Science University (which is a mere 2 hours away) will be participating, as they often do.
OHSU is a great institution (I interviewed there for fellowship many years ago) and they participate in many MS clinical trials.
Great info as always. Question: Does everyone with MS eventually develop or have Smouldering MS?
Following because that's good question and I've been concerned about that
There are definitely some people with MS for many decades who remain stable (so called "benign MS") as explained in this video: czcams.com/video/t4tvdSwNE3k/video.html
Thank you for great explanation. I’m a bit late-Dr. Gretchen Hawley shared it recently-but can I ask a dumb question? I have been on a low-tyramine diet for many years to help with chronic, intractable migraines (the same diet used for MAOI inhibitors and Familial Dysautonomia). Is there any correlation between the elimination diet and the BTKI drugs?
Oh, that dimethyl fumarate number compared to the placebo is disheartening! My daughter is on Vumerity, although not the same but close, for the last 2 years. MRI results just came back, no new lesions since she started, whew
Are these paramagnetic rim lesions also called 'black holes'? Because they did show up in my last MRI. I'm only 31, following the OMS program for 4 years now and I'm on Tysabri for 3 years. My symptoms didn't really get worse over the past years but those 'black holes' related to an ongoing silent inflammation leaves me concerned.
Thanks for your really helpful and revealing videos all the time by the way!
"black holes" are different and refer to multiple sclerosis lesions which appear dark on T1 sequences.
So my thoughts on BTKs. They might be best for those with no active lesions and NEIDA as if they do penetrate CNS it might dramatically impact SAW vs current DMTs. From the sounds of things someone with active disease might still want Tysabri, b cell depleters or IRT to calm the inflammation and then switch to a BTK.
I do agree that they drugs may be less effective than Tysabri and b-cell depleters for young people with relapsing MS.
I did absolutely amazing on Tysabri, but then couldn't afford it so joined this study. I wish I could go back on Tysabri so much.
Thank you for the video. The scans that could see smouldering MS were interesting. Is that somehting available for neurologists to order for their patients now or are they specialized machines? Was wondering if MS neurologists would start ordering those special scans in the future or not? 🤔
They're not commercially available right now, and there would be no reason to do them unless there was a way to take action based on the result.
Thank you Dr. Beaber for the BTKI video. It showed an interesting new approach in Phase III trials. I with other commenters requested the video a few weeks ago.
In addition, I suggest a future video about remyelination drugs. Many are proposed, but I don’t know of any that made it to Phase II or III trials.
Here is a video on clemastine you may appreciate: czcams.com/video/T6p5e2TcR9Q/video.html
great content!
Thanks!
Great video as always. Thank you! I really want to join a clinical trial to contribute to the understanding of MS (diagnosed beginning of this year, started ocrevus), but cant find any that i could join as im already on a DMT
There are plenty of observational studies like this one: clinicaltrials.gov/study/NCT05633875?cond=Multiple%20Sclerosis&aggFilters=studyType:obs&rank=1 Try looking at the studies in this search for observational studies: www.clinicaltrials.gov/search?cond=Multiple%20Sclerosis&aggFilters=studyType:obs
@@DrBrandonBeaber Thank you for your response! The study you linked has an inclusion criteria would exclude me though right? Enrolled in a protocol for at least 8 years? I will take a further look into the observational studies. :)
@@MrMikk532 Maybe. I just posted it as an example.
Hello Dr. Brandon! Thanks for making this video. I was diagnosed last year and not yet on Dmts hoping for new drugs that dont have these side effects. Ive been having constant infections despite not being on meds and im constantly relapsing. Ive been in a wheelchair for 2 months now because i havent been able to take steroids and the infections lead to ths horrible relapse. Do relapses from infections lead to permanent disability? Everytime i try to stand or walk i feel like collapsing. Spasticity weakness all from antibiotics and infections. From your experience is it possible to recover and walk again and do steroids work after these infections? Thanks Dr. B🙏
It a very beautiful thing to see myself healthy again after using remedy from Dr Ake on CZcams, I finally got cured of my Multiple Sclerosis with his herbs med and I can tell how great my health has turned out so far.
Thank you 🙏 ❤️🫣💕
I don’t fully understand - exactly how do these class of BTKs operate and how different are they from the classic B cell chemo drugs like Acalabrutinib? Do we have much data on the role that BTK plays on plasma b cells? More data at the moment showing long Covid, which will be a huge market, needs to target this level mainly
Hi Doc!, Thanks a lot for this video, when do you think BTK inhibitors will be available in the market? 2026 ? Thanks a lot again,
Any videos with info on Frexalimab?
Also, serrapeptase?
Thanks for the suggestion. I may do a video on frexalimab once all the data are released.
What about these for patients as an extra layer of protection? Had Lemtrada and am doing fantastic. I would consider using these as an extra layer of bubble wrap....
We probably won't have any data on combining BTK inhibitors with other disease modifying therapies for a long time.
Thank you for the video. I am curious if tyrosine kinase is in any way similar the the supplement l-tyrosine.
Tyrosine is the amino acid which is phosphorylated by the tyrosine kinase enzyme.
I have been diagnosed with PPMS for 7 years. I’ve recently started taking l-tyrosine supplements daily and have noticed improvements in my mobility after about 1 month of taking it. My reason for taking it is because l-tyrosine increases norepinephrine and helps the body deal with the fight or flight stress response? Does l-tyrosine have similar effects to tyrosine inhibitors?
I'm sorry I don't have the answer to your question but I have the same question! I hope you get an answer
How much ltyrosine do you take? X
Hello Dr. Iam on ofatumumab and I would like to know, if a change to the BTKs would be a good idea? Had one relapse in 2015 and the second in 2022 in the brainstem.
I can't give you personal advice here. My opinion is that these drugs actually may be less effective than b-cell depleters for young people with relapsing MS.
Thanks Dr Beaber. Can you please follow up when results are available on the head to head trials. BTW is it O.K. if I just call you "The Beabs" 🙂
I will follow up once more data is published.
What do you think about Pam Bartha who teaches that MS can be as a result of parasites. What do you think about the Dr Wahl protocol book
I have a playlist related to Dr. Terry Wahls: czcams.com/video/GTC9oBqtc4g/video.html I am not familiar with Pam Bartha, but there is actually evidence that MS is more common in areas with the parasite burden is lower.
Hello, I think I would like to be a part of a study of this drug.
cause there are masses of not working drugs in Ms, i have no clue which one to take. I sometimes think before i answered that question im below earth.
meanwhile MS, Tinitus and Impingement in arm, for 38 its a tough combination
Yep
During HSCT (CY 200mg/kg+ATG) I was told that it had 'wiped out' both the innate and adaptive immune systems. Do you know if there is a rationale for using BTKi after HSCT? Thanks!
Needless to say, there is not definitive answer to your question, but if someone has progressive MS after HSCT and a BTKI is shown to be effective in progressive MS, I don't see why not. By the way, Cyclophosphamide 200mg/kg is generally speaking non-myeloablative and may preserve cells of the innate immune system such as neutrophils.
How ARE the clinical trials going?? When ARE BTK Inhibitors expected to be authorized for use? My neurologist at Hadassah claims that they're not proving themselves as effective as was hoped. ☹️ And I am EXACTLY the candidate this was geared towards - older, late diagnosis, PPMS, insidious PIRA (= Progression IRrespective of Anything). 😝
Possibly in a few years if the PERSEUS trial (tolebrutinib vs. placebo) is effective).
Great explanation of everything. It’s great to see so many different trials, as even in treatment we are a snowflake ❄️ disease.
#Sharingiscaring
How long does it take to turn off Kesimpta?
Is it possible to mix BTK inhibitors with B-cell depleters such as Ocrevus? Are there any possible contraindications/benefits?
This has not yet been studied. There is a potential risk of more immunosuppression and infections.
@@DrBrandonBeaber Got it, thank you for your response, Dr. Beaber.
I hate that “smouldering” has become the word to use. My disability is continuously worsening. I’m approaching 8 years since diagnosis and my EDSS (self-assessed) has kind of gone up one pt. each year (approaching year 8). As if the word “sclerosis” isn’t bad enough, to imagine my body smouldering is so anxiety-inducing.
Yeah, in Hebrew it sounds even worse! 😅
I’m not sure what med you’re on, but Briumvi is said to help calm down the inflammation of old lesions (smoldering). I don’t like the term either!
Doctor, I don't understand how a study can be open label and double blind at the same time? Can you please explain this to me because I'm currently in the process of joining an "open label" study related to a BTK inhibitor vs Aubagio?
If it is "open label," the treatment is known to the participants, so it is not blind. This must be a miscommunication. Do you have a link to the clinicaltrials.gov site?
I mean, when you talked about the clinical trial with Evobrutinib vs placebo vs Tecfidera you said that it was a double blind study and then you said that it was open label (it says so in the description too), in the 14th minute of this video. Was that a mistake or am I misunderstanding something?
Are there any upcoming/recent trials pitting a drug vs HSCT?
It a very beautiful thing to see myself healthy again after using remedy from Dr Ake on CZcams, I finally got cured of my Multiple Sclerosis with his herbs med and I can tell how great my health has turned out so far.
Thank you 🙏 ❤️🫣
There is no point as all DMT eventually fail.
@@mary-vy3mo try herbs holistic medication
Why are they choosing lower efficacy drugs to compete against in head to heads?
So their drug will look good.
When could we hope to see this btki in standard clinical practice?
If the phase III trials for fenebrutinib or tolebrutinib are successful, perhaps in 2-3 years.
what is palacebo PERSEUS. Is it a placebo with a fancy name for an air of legitimacy?
Currently on Ocrevus! I would be interested if I had access to MRI data that shows if I have indications of smoldering (though I suspect I do). It’s frustrating as a patient to make vital choices about drug choice based on incomplete (but theoretically obtainable) personal health information. It’s like throwing a dart at a board with your eyes closed …but the outcome affects your whole life.
Incidentally- any chance of asking my neurologist (Dr. Green, UCSF) for this kind of diagnostic? What would be the right question/request if I were to bring the request to him?
It a very beautiful thing to see myself healthy again after using remedy from Dr Ake on CZcams, I finally got cured of my Multiple Sclerosis with his herbs med and I can tell how great my health has turned out so far.
Thank you 🙏 ❤️🫣💕
Well, will there ever be a point when conventional medicine addresses the causes of patient inflammation or will we always have to search out a functional, naturopathic, holistic doctor for that type of care?
I have been going to my wife’s neurologist with her for ten years now and not seen one MRI. I would like to see all of them taken over the years and discuss the changes that have taken place over the years. Any suggestions for making that happen?
And bless the souls indeed who agreed to do an unnecessary spinal tap for science xD They are better people than me xD
Indeed
I have PPMS with no new lesions but I’m experiencing other progressive symptoms of tingling in my extremities and increased need of my walker instead of my cane. I wouldn’t qualify for any of the testing because I do use a walker regularly.
It a very beautiful thing to see myself healthy again after using remedy from Dr Ake on CZcams, I finally got cured of my Multiple Sclerosis with his herbs med and I can tell how great my health has turned out so far.
Thank you 🙏 ❤️🫣💕
How long before your diagnosis symptoms started?
Sadly they don't look that promising in the short term maybe they are way effective in the long term
Genuinely curious, what makes you say that? It’s not working in short term?
@@jayl6712it's got so hyped(finally not a mee too drug) but from the video their short term effect on stopping relapses isn't better than current dmt but it seems their goal is to stop progression (pira) which is why i said their effectiveness will be much better in the long term, we have to wait years to see that although their safety profile seems impressive compared to the current dmt, personally I am eagerly waiting for Remilynation therapies maybe that's why I am pessimistic .
@@jayl6712Evobrutnib failed at beating Aubagio in relapse rate.
i was in the evobrutinib trial 😂 as soon as i found out i was taking aubagio i was out of there....not before aubagio raped my liver
How did you find out during the trial? I had liver issues and mental health issues. I didn't find out until I was admitted and they needed to know which med I was on to treat other issues.
@@JegTreSpillerDama my other tablets tasted like sugar, only the aubagio was a solid tablet, me and my nero knew after the first dose i took
@@JegTreSpillerDama i could literally sweeten my coffee with the "evobrutanib" tablets
ددددددددددددددددددد
?
@@DrBrandonBeaber sorry...unintentional!
@@abcdef12261 I see