Alemtuzumab, is one course enough?

...... data suggest that induction of disease remission for some patients might occur following just one dose of alemtuzumab. 

Kocsik AS, Klein DE, Liedke M, Kaunzner UW, Nealon NM, Gauthier SA, Vartanian T, Perumal JS. Induction of disease remission with one cycle of alemtuzumab in relapsing-remitting MS. J Neurol. 2018 Apr 17. doi: 10.1007/s00415-018-8845-4. [Epub ahead of print]


To investigate a single-course treatment with alemtuzumab in patients with relapsing-remitting multiple sclerosis.


We performed a retrospective chart review of all patients diagnosed with RRMS who were treated with alemtuzumab at our MS center and who had at least 12 month follow-up since the first dose. Data on radiological and clinical relapse were collected for the 2 years prior to patients' first dose of alemtuzumab and were tracked until the time of analysis.


In the 2 years prior to first dose of alemtuzumab, 82.8% of the 29 patients had a new lesion on MRI and/or a clinical relapse, with an ARR of 0.67. In the mean 24.7 month follow-up after the first dose of alemtuzumab, 17.2% of patients displayed new disease activity and the ARR was 0.08. 4 out of 5 patients who relapsed did so within 12 month post-first infusion and received a second dose. Of the 24 patients who did not relapse, 8 received a second dose at 1 year and 16 did not. 5 out of all 29 patients developed thyroid disorder.


Given that 96% of patients who did not relapse in the first 12 months following the initial dose of alemtuzumab remained relapse-free regardless of receiving a second course of drug, our data suggests that induction of disease remission for some patients might occur following just one dose of alemtuzumab. With further study, these data could support modification of the current therapy regimen.

So in this cohort, 20% did not have active disease for 2 years prior to therapy. Then a number who were started on alemtuzumab about 65% did not complete their course. However, many did not relapse suggests that some people get their benefit from one course. This is no doubt true. Look at HSCT. They get depleted once and do very well. We have seen this with rituximab treatment too. However if you fail in year two because you did not complete your prescribed course who are you going to blame, yourself or your neuro for not following prescribing guidelines. You would need a trial to show this.