Alemtuzumab was more beneficial to patients with relapsing remitting multiple sclerosis than subcutaneous interferon beta 1a in various measures of preexisting disability, according to recent findings.
Researchers from the Queen Mary University of London conducted a two-year head to head phase 3 trial to characterize the effects of alemtuzumab treatment on measures of disability improvements in patients with inadequate response to prior therapy. The study participants were administered either alemtuzumab 12 mg (202 patients) or subcutaneous interferon beta 1a 44 μg (426 patients) throughout the study period. The team observed their disability outcomes using scales such as the Expanded Disability Status Scale (EDSS), Multiple Sclerosis Functional Composite (MSFC), and Sloan low contrast letter acuity scales.
The patients underwent the MSFC three times before baseline, followed by every six months through the study. That scale, described as a “multidimensional instrument” included measures of neurologic performance across three main areas: upper limb coordination and dexterity, ambulation (including a walking test) and cognitive function. Visual function was additionally assessed every six months.
The researchers determined EDSS improvement was more likely to occur in alemtuzumab patients than interferon beta 1a patients from baseline to month 24. Also, the alemtuzumab group was more likely to demonstrate improvement in all seven EDSS functional systems, compared to the interferon beta 1a group, and reached statistical significance in five domains: cerebral, cerebellar, sensory, pyramidal, and visual.
Alemtuzumab patients had twice the chance of developing a three-month confirmed disability improvement (CDI) compared to the other group. Interestingly, the relapse rate between the alemtuzumab and interferon beta 1a groups was similar, the researchers reported: 32% vs. 33%, respectively.
The team noted that the six-month confirmed improvement was also greater in the alemtuzumab group that the interferon beta 1a group in MSFC based outcomes; the interferon beta 1a group was significantly more likely to experience worsening MSFC than the alemtuzumab patients.
Among measures of the low contrast visual tests, alemtuzumab patients had “more favorable outcomes” than the interferon beta 1a patients. Visual acuity was deemed stable at 2.5% contrast and at 100% contrast in the alemtuzumab group, while interferon beta 1a patients had a decline in visual acuity at 1.25% contrast, 2.5% contrast, and 100% contrast at different assessment periods throughout the study.
“Alemtuzumab was more effective than interferon beta 1a at improving disability outcomes, significantly reducing the risk of six-month confirmed disability worsening, and increasing six month CDI,” the study authors concluded. “The clinical efficacy of alemtuzumab versus interferon beta 1a was maintained regardless of the type of prior disease modifying therapies. The current analysis demonstrates that, in patients with relapsing remitting multiple sclerosis with an inadequate response to prior disease modifying therapies, alemtuzumab provides greater recovery of function across several disability measures than interferon beta 1a.”
The study, “Alemtuzumab improves preexisting disability in active relapsing remitting MS patients
,” was published in the journal Neurology
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