Alemtuzumab Efficacy and Safety for Multiple Sclerosis

AUGUST 24, 2015
MD Magazine Staff

The MD Magazine Peer Exchange "Modifying the Course of Multiple Sclerosis in New Ways: The Latest Advances in Treatment" features a distinguished panel of physician experts discussing key topics in multiple sclerosis (MS) research and management, including the latest insights into MS pathophysiology, new medication options and their application in clinical practice, and more.
This Peer Exchange is moderated by Paul Doghramji, MD, who is a family physician at Pottstown Memorial Medical Center in Pottstown, PA, and medical director of Health Services at Ursinus College, in Collegeville, PA.
The panelists are:
  • Fred D. Lublin, MD, FAAN, FANA, the Saunders Family Professor of Neurology and director of The Corinne Goldsmith Dickinson Center for Multiple Sclerosis, and co-chief editor of Multiple Sclerosis and Related Disorders at the Icahn School of Medicine at Mount Sinai
  • Patricia K. Coyle, MD, professor of neurology, vice chair of Clinical Affairs, and director of MS Comprehensive Care Center
  • Suhayl Dhib-Jalbut, MD, professor and chief of the Department of Neurology at Rutgers, Robert Wood Johnson Medical School
Alemtuzumab was tested head-to-head against high-dose, high-frequency interferon beta-1a. According to Lublin, the comparator “was a very effective therapy for MS,” and yet alemtuzumab “pretty much bested it in most metrics.” He explained that it is a very potent agent that “lyses all of your T cells and B cells,” thereby depleting cells that could potentially cause attacks.
With its potency comes “a very complicated risk mitigation plan” to manage its safety risks, Lublin said. Included in the list of potential issues to monitor for are infections, low platelet counts, ITP, thyroid function, kidney disease, glomerular basement membrane disease, and other glomerulonephritides. Prophylactic treatment for herpetic infections is used for a period of time after initiation, and steroids are administered before the alemtuzumab infusion is started.
Even though the administration of the drug is not frequent – 5 days followed by 3 days a year later and then nothing unless breakthrough activity occurs – patients treated with alemtuzumab need to be monitored every month for 4 years after the end of therapy, said Coyle, which complicates its use.

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