According to recent study Multiple Sclerosis (MS) therapy alemtuzumab can trigger severe and unpredictable side effects. The team, led by Prof Dr Aiden Haghikia and Prof Dr Ralf Gold from the Department of Neurology of the Ruhr-Universität Bochum at St. Josef's Hospital, focused on two patients whose infusion of alemtuzumab significantly worsened symptoms.
The team also describes a treatment that successfully curbed the harmful side effects. Haghikia said: “This therapeutic algorithm could help MS patients around the world who develop similar side effects under alemtuzumab.”
Alemtuzumab (brand name Lemtrada) is a treatment for relapsing remitting MS. The disease modifying drug is taken as an intravenous infusion in two treatment courses over a 12 month period. It is thought that it can reduce the number of relapses by around 70%, compared to taking a placebo.
Any common side effects experienced due to an infusion related reaction are usually mild and short-lived, but there is an increased risk of infection following treatment. The less common but potentially very serious side effects that can also occur include thyroid disorder, kidney and blood clotting problems.
Alemtuzumab is a therapeutic antibody that docks to the protein CD52 on the surface of certain immunocytes, mainly T- and B- cells (lymphocytes, which play a central role in cell-mediated immunity), leading to the depletion of almost all lymphocytes.
The drug is approved as an escalation therapy for patients with multiple sclerosis with active disease defined by clinical or imaging features. In phase three clinical trials, the drug was more effective than interferon beta-1a in reducing relapses and brain volume loss. However, concerns have been raised due to its numerous adverse effects.
The two patients – a woman aged 25 and a man aged 41 – described in the Lancet Neurology study received alemtuzumab because they had highly active MS. Six months after the treatment, these symptoms had worsened significantly. Using MRI, the researchers discovered a kind of new inflammation mode: they found vast areas in the brain with numerous ring enhancing lesion. The patients had not displayed this pattern in their previous medical history.
It is currently unclear whether the observed adverse events represent increased MS activity or an independent secondary autoimmune process.
The neurologists were able to curb the side effects and the ring-shaped deposits that has appeared in the brain receded. Both patients were treated with vituximab. For the male patient this treatment resulted in a near absence of contrast-enhancing lesions and nine months later the patient was almost free of the symptoms that prompted admission. The female patient also saw her symptoms improve and she has since stabilised as determined by clinical and MRI measures.
The authors propose that the measures they applied could also benefit other patients who develop similar adverse events under alemtuzumab.