Research: alemtuzumab allows eye sight to improve

#MSBlog: Is it unrealistic to expect an improvement in your condition with early aggressive treatment? 

Epub: Graves et al. Alemtuzumab improves contrast sensitivity in patients with relapsing-remitting multiple sclerosis. Mult Scler. 2013 Mar.

BACKGROUND: Alemtuzumab is a monoclonal antibody directed against CD52 that depletes T and B lymphocytes. 

OBJECTIVE: To evaluate the treatment effect of alemtuzumab on low-contrast vision in relapsing-remitting MSers. 

METHODS: This was a pre-defined exploratory analysis within a randomized, rater-blinded trial (CAMMS223) that was run at 49 academic medical centers in the US and in Europe. MSers with untreated, early, RRMS (McDonald, n = 334) were randomized 1:1:1 to subcutaneous interferon beta-1a (IFNB-1a), or alemtuzumab 12 mg or 24 mg. Visual contrast sensitivity was measured for each eye at baseline and quarterly, with Pelli-Robson charts. 

RESULTS: The eyes of MSers in the pooled alemtuzumab group (versus IFNB-1a) had a greater than 2-fold higher rate of both 3-month and 6-month sustained visual improvement, of at least 0.3 log units (2 triplets, 6 letters) (At 3 months the hazard ratio (HR) = 2.26; CI = 1.19 to 4.31; P = 0.013; and at 6 months the HR = 2.44; CI =1.16 to 5.15; P = 0.019), and they had a lower risk of 3- and 6-month sustained worsening of at least 0.15 log units (1 triplet, 3 letters) (At 3 months the HR = 0.58; CI = 0.38 to 0.89; P = 0.012; and at 6 months HR = 0.55; CI=0.35 to 0.87; P = 0.010). Over the 36-month study period, the eyes of MSers in the pooled alemtuzumab group improved in mean contrast sensitivity to a greater extent than those in the IFNB-1a group (0.080 log units versus 0.038 log units; P = 0.0102). 

CONCLUSIONS: Alemtuzumab was associated with a greater chance of improved contrast sensitivity in MSers with RRMS and may delay the worsening of visual function. Contrast sensitivity testing was sensitive to treatment effects, even within an active comparator study design. These results support the validity of low-contrast vision testing as a clinical outcome in MS trials. 

CoI: please note I have multiple conflicts of interest in relation to alemtuzumab and natalizumab as well as other aggressive therapies (cladribine, ocrelizumab, etc.)


"Another clinical outcome that improves post-alemtuzumab. Who says MSers shouldn't expect an improvement with more aggressive therapies. Why is this study important? It is important because the visual outcome measure used is objective. With these and other results in relation to alemtuzumab and natalizumab (it has similar data) I wonder why people question my affinity for early aggressive treatments. Not only does it prevent the accumulation of disability, but a significant number of MSers actually improve with therapy."

"The outstanding qustion with alemtuzumab is the one that will only be answered with extended follow-up. Does it cure some MSers of MS?"
Other posts of interest in relation to the latter point:

12 Feb 2013
#MSBlog: Defining an MS cure. "I have been having several recent discussions with colleagues about whether or not we can cure MS. I think we can, but we need to know what a cure means to do this. We used the opportunity ...
14 Feb 2013
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20 Nov 2012
Research: Antigen-coated beads the New (Old) Cure of the Week. Daniel R Getts, Aaron J Martin, Derrick P McCarthy, Rachael L Terry, Zoe N Hunter, Woon Teck Yap, Meghann Teague Getts, Michael Pleiss, Xunrong Luo, ...
12 Oct 2012
I would say it is half the cure or maybe a third as I will explain. The other half has already been tried in MS and it is safe. If this half is safe, which appears to be the case, you put the two halves together and relapsing MS is ...

01 Feb 2012
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02 Jun 2011
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06 Apr 2012
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23 Sep 2011
MouseDoctor says 50% reduction IS NOT A CURE, this is bad reporting and over-hyping again creating false expectations... so lets look at the story. This is from a publication. Noorbakhsh F, Ellestad KK, Maingat F, Warren KG ...

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