Alemtuzumab effectively reduced disease activity for patients with relapsing-remitting multiple sclerosis (RRMS) with refractory disease activity despite fingolimod treatment, according to results published in the Journal of Neurology.
Further studies should be undertaken to confirm these findings and to assess safety concerns during longer-term follow-up.
The study included clinical and magnetic resonance imaging data from 9 large German MS centers on patients with RRMS with a history of switching treatment from fingolimod to alemtuzumab (n=50).
Participants with an average disease duration of 12.9 years and median Expanded Disability Status Scale score of 3.0 at baseline switched to alemtuzumab after an average of 68 weeks of fingolimod treatment. Participants were followed for a mean of 64 weeks after switching.
Participants who switched to alemtuzumab showed a decrease from 2.2 to 0.34 in the annualized relapse rate, and their Expanded Disability Status Scale scores stabilized.
In a subgroup of participants (n=23), magnetic resonance imaging data showed a reduction in enhancing (4.47 vs 0.26) and new/enlarging T2 (5.8 vs 0.27) lesions after treatment adjustment.
Of all 50 participants, 2 experienced autoimmune adverse effects and 1 experienced severe infection. In addition, 1 participant suffered combined lethal necrotizing leukoencephalopathy and hemolytic anemia.
“We propose to wait for normalization of preceding lymphopenia after stopping fingolimod and before switching to alemtuzumab to minimize the potential risk of severe side effects or therapy failure,” the researchers cautioned.
In summary, these results suggest alemtuzumab may be an effective therapy in patients with RRMS with refractory disease activity despite fingolimod treatment.
Huhn K, Bayas A, Doerck S, et al. Alemtuzumab as rescue therapy in a cohort of 50 relapsing-remitting MS patients with breakthrough disease on fingolimod: a multi-center observational study [published online April 25, 2018]. J Neurol. doi: 10.1007/s00415-018-8871-2