According to research, switching treatments from Gilenya (fingolimod) to Lemtrada (alemtuzumab) can trigger significant and unexpected disease activity in MS patients.
Clinicians from six centres across Europe – three in Britain, one in Denmark, one in Sweden and one in the Netherlands – treated 174 patients with Lemtrada combined. Thirty-six of those people had previously taken Gilenya and of those 36, nine showed unexpected and significant disease activity following the switch.
Researchers explained that this unexpected activity, despite Lemtrada’s established efficacy, may be the result of prolonged sequestration of auto-reactive immune cells in the lymph nodes following Gilenya withdrawal. This sequestration would allow such cells to be concealed from the usual biological effect of Lemtrada of neutralising them. Once the drug’s effect has passed, these cells could re-emerge from the lymph nodes and reactivate the disease.
The authors of the study suggested that these cases may illustrate an important cause of reduced efficacy of alemtuzumab in a venerable group of patients with MS, who are most in need of disease control.
They also recognised the potential for selection bias in this case series, the degree of disease activity observed in these cases spontaneously and independently caught the attention of clinicians in different centres and may represent an important cause of lack of therapeutic efficacy in a group of patients most at need of disease control.
Further studies including detailed immunophenotyping are required to confirm these phenomena and may have relevance in understanding causes of disease reactivation in general.
In addition, future trials addressing longer-term outcomes need to be addressed in order to guide clinicians on strategies for treatment switches.
Lemtrada is an antibody that targets and destroys T- and B-cells in the immune system. Previous clinical trials have shown that Lemtrada reduced relapse frequency in MS patients by up to 74 per cent, and reduced annualised relapse rates from 2.1 to 0.2.
Source: MS-UK (07/02/17)