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A to Z of MS Alemtuzumab

Product name

Campath-1h

Alemtuzumab is an experimental drug treatment for people with relapsing/remitting MS. Alemtuzumab is already licensed for use in B-cell chronic lymphocytic leukaemia, a type of cancer.

In a trial comparing alemtuzumab with beta interferon 1a, people with relapsing/remitting MS receiving alemtuzumab experienced significantly fewer relapses over three years. Disability levels also improved and this improvement continued for up to three years after treatment.

A study of 25 people with secondary progressive MS showed reduced activity on MRI scans but the people continued to accrue disability.

How alemtuzumab works

Alemtuzumab is a type of drug called monoclonal antibodies. Alemtuzumab acts by killing T-cells which form part of the immune system and which in MS mistakenly attack myelin and cause the inflammation seen on MRI scans. It is thought that the T-cells regenerated following treatment with alemtuzumab will not include those that destroy myelin.

How is alemtuzumab given?

In trials alemtuzumab is given by a course of infusions over three to five days once a year.

Side effects and contraindications

The use of alemtuzumab in this clinical trial was voluntarily suspended in September 2004 following one fatal case of immune thrombocytopenic purpura (ITP), a blood clotting disorder. Other cases of ITP were identified and treated. ITP is not fatal if caught early enough, however, it remains a significant risk.

Almost a quarter of participants developed thyroid-related side effects. These are treatable but can mean lifelong thyroid medication.

Flu-like symptoms after infusion were reported. As alemtuzumab works by suppressing the immune system, anyone on treatment will be more vulnerable to infections such as colds and viruses for some time after the infusion.

References

Coles AJ, et al.
The window of therapeutic opportunity in multiple sclerosis: evidence from monoclonal antibody therapy.
Journal of Neurology 2006; 253(1): 98-108.

Coles AJ, et al.
Alemtuzumab vs interferon beta-1a in early multiple sclerosis.
New England Journal of Medicine 2008; 359: 1786-1801.

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