Alemtuzumab Improves Disability, Prognosis in Treatment-Refractory MS

The following article is part of conference coverage from the 34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) in Berlin, Germany. 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 ECTRIMS 2018.

A 36-month regimen of alemtuzumab was associated with improvements in disability among patients with treatment-refractory multiple sclerosis (MS) in a study presented at the 34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis meeting, held October 10 to 12, 2018, in Berlin, Germany.

“Early studies suggested less alemtuzumab benefit in progressive, disabled patients. High-disability, active, refractory patients complicate design of randomized trials,” study presenter Samuel F. Hunter, MD, PhD, wrote. “Use of [study participants] with historical data and using MS Severity Score (MSSS) allow simpler open-label trial designs, which reveal long-term responses.”

Two groups composed of patients with treatment-refractory MS, including alemtuzumab-experienced (n=30) and alemtuzumab-naive (n=30) groups, were enrolled in an open-label alemtuzumab study. Study investigators assessed the changes in the Expanded Disability Status Scale (EDSS) and MSSS after up to 7 courses of alemtuzumab during the 36-month study. In addition, the researchers collected pretrial retrospective data on relapses as well as EDSS for evaluating prognosis-related changes.

In the alemtuzumab-experienced group, the median time on treatment was approximately 6 years. The researchers noted that relapses were possible despite noticeable improvements or stabilization in EDSS, MSSS, and imaging.

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Disability reversal with recurrent exposure to alemtuzumab was noted in some patients with secondary progressive relapses. Safety outcomes were consistent with the previously known risks of alemtuzumab.

“High disability, refractory MS patients often improve in disability and nearly always improve in prognosis (by the MSSS) with long-term alemtuzumab, with greater responses reflecting neurorestoration in many subjects,” Dr Hunter reported in the abstract. “Relapse responsiveness in this high corticosteroid cohort is unremarkable early in therapy. Intermittent corticosteroid therapy and infrequently other therapy is needed to address relapse related disabilities emerging in the setting of improved baseline disability.”

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Hunter SF. Alemtuzumab (ALE) achieves significant long-term improvement of disability and prognosis following rescue therapy in treatment-refractory MS. Presented at: 34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis. October 10-12, 2018; Berlin, Germany. Abstract P906.