Epub: Coles AJ. Alemtuzumab Therapy for Multiple Sclerosis. Neurotherapeutics. 2012 Nov 27.
Alemtuzumab is a humanized monoclonal antibody that is administered
daily for 5 days, and then no further therapy is required for 12 months.
It causes rapid and prolonged lymphocyte depletion; the consequent
homeostatic reconstitution leads to a radically reformed lymphocyte pool
with a relative increase in regulatory T cells and expansion of
autoreactive T cells. Although previously licensed for the treatment of
B-cell chronic lymphocytic leukemia, it is now been considered for
licensing in the treatment of multiple sclerosis
(MS). From a disappointing experience with alemtuzumab in progressive
MS, Alastair Compston and I argued that immunotherapies should be given
early in the course of the disease. In a unique program of drug
development in MS, alemtuzumab has been compared in 1 phase 2 trial and 2
phase 3 trials with the active comparator interferon beta-1a. In all
trials, alemtuzumab was more effective in suppressing relapses than
interferon beta-1a. In one phase 2 and one phase 3 trial, alemtuzumab
also reduced the risk of accumulating disability compared with
interferon beta-1a. Indeed, alemtuzumab treatment led to an improvement
in disability and a reduction in cerebral atrophy. The safety issues are
infusion-associated reactions largely controlled by methylprednisolone,
antihistamines, and antipyretics; mild-to-moderate infections (with 3
opportunistic infections from the open-label experience: 1 case each of
spirochaetal gingivitis, pyogenic granuloma, and Listeria meningitis);
and autoimmunity. Usually autoimmunity is directed against the thyroid
gland, but causes (1 %) immune thrombocytopenia, and in a few cases
antiglomerular basement membrane syndrome. Alemtuzumab is an effective
therapy for early relapsing-remitting MS, offering disability
improvement at least to 5 years after treatment. Its use requires
careful monitoring so that potentially serious side effects can be
treated early and effectively.
The summary of CAMPATH in a nutshell except he forgot to say that the company producing it are going to whack the price up to extort more cash from MSers. They have been publicly silent after Prof G put done the guantlet because how do they justify it.