Alemtuzumab Reduces MRI Disease Activity, Brain Volume Loss in Relapsing-Remitting MS

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Researchers sought to assess MRI lesion outcomes and BVL over a 7-year period in patients assigned to alemtuzumab in the CARE-MS II trial.
Researchers sought to assess MRI lesion outcomes and BVL over a 7-year period in patients assigned to alemtuzumab in the CARE-MS II trial.
The following article is part of conference coverage from the 2018 Annual Meeting of the Consortium of Multiple Sclerosis Centers in Nashville, Tennesssee. Neurology Advisor's staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from CMSC 2018.

Alemtuzumab is associated with reduced magnetic resonance imaging (MRI) disease activity and the slowing of brain volume loss (BVL) over 7 years in patients with relapsing-remitting multiple sclerosis (MS), according to a study presented at the 2018 Annual Meeting of the Consortium of Multiple Sclerosis Centers, held May 30-June 2 in Nashville, Tennessee.

Researchers sought to assess MRI lesion outcomes and BVL over a 7-year period in patients assigned to alemtuzumab in the CARE-MS II trial. The 7-year period was comprised of 2 years in the core study and 4 additional years in the extension trial, as well as 1 year in TOPAZ. Patients in the TOPAZ trial received retreatment of 12 mg/day alemtuzumab on 3 consecutive days for ≥12 months following the most recent course of therapy. Investigators examined annual MRIs for disease activity, with specific attention paid to new gadolinium-enhancing lesions, new/enlarging T2 lesions, new T1 hypointense lesions, and BVL. BVL was assessed by the relative change in brain parenchymal fraction (BPF).

A total of 317 patients in the TOPAZ trial completed year 1 and year 7 following initiation of alemtuzumab treatment. After the initial 2 courses of therapy, approximately 88% of patients did not receive another DMT. In addition, approximately 47% of patients did not receive alemtuzumab retreatment or another DMT. By year 7, up to 67% of patients were free of MRI disease activity, whereas new gadolinium-enhancing lesions, new/enlarging T2 lesions, and new T1 hypointense lesions were reported in 90%, 67%, and 88% of patients, respectively.

Treatment with alemtuzumab resulted in a significant reduction in the median annual change in BPF compared with SC IFNβ-1a during 2 years (Y1: −0.48% vs −0.54%, Y2: −0.62% vs −0.81%; P =.0121 vs SC IFNβ-1a in Y2). These changes remained low in patients treated with alemtuzumab during years 3-7 (Y3: −0.10%, Y4: -0.19%, Y5: −0.07%, Y6: −0.10%, Y7: −0.14%).

"Alemtuzumab durably reduced MRI disease activity and slowed BVL over 7 years in patients who were initially randomized to alemtuzumab in CARE-MS II, despite 47% receiving no additional treatment after the initial 2 courses,” according to the researchers. “Alemtuzumab provides a unique treatment approach for relapsing-remitting MS patients, offering durable efficacy without continuous treatment.”

For more coverage of CMSC 2018, click here.

Reference

Pelletier D, Traboulsee A, Barnett M, et al; for the CARE-MS II, CAMMS03409, and TOPAZ Investigators. Durable improvements in magnetic resonance imaging disease activity and brain volume loss with alemtuzumab in patients with relapsing-remitting multiple sclerosis: 7-year follow-up of CARE-MS II (TOPAZ study). Presented at: 2018 CMSC Annual Meeting. May 30-June 2, 2018; Nashville, Tennessee. Abstract DX65.

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