MS Speaks
Multiple Sclerosis => TREATMENTS => LEMTRADA (Campath, alemtuzumab) => Topic started by: agate on April 05, 2016, 10:54:50 am
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There is a letter in the "Observation" section of the current issue (April 4) of JAMA Neurology. The authors describe a case of nocardiosis occurring in an MS patient who went on alemtuzumab 18 weeks after stopping Tysabri, which she had been taking for nearly 7 years.
This URL will show most of the letter. Unfortunately the last part of it is unavailable at present.
http://amaprod.silverchaircdn.com/data/Journals/NEUR/0/nlo160001.pdf.gif (http://amaprod.silverchaircdn.com/data/Journals/NEUR/0/nlo160001.pdf.gif)
Nocardiosis is often curable but if it is the disseminated variety, it is only 67% curable. (The patient being discussed seems to have survived but only after 10 days of hospitalization with a ventilator.)
An overview of nocardiosis can be seen here (Medscape eMedicine) (http://emedicine.medscape.com/article/224123-overview).
When a medical journal also editorializes about an article in an issue, it seems to be a way of calling particular attention to that article. This April 4 issue of JAMA Neurology contains an editorial about this problem with alemtuzumab:
http://amaprod.silverchaircdn.com/data/Journals/NEUR/0/ned160008.pdf.gif (http://amaprod.silverchaircdn.com/data/Journals/NEUR/0/ned160008.pdf.gif)
Again, only part of the editorial can be seen but a couple of points stand out in it:
1 - The patient was very underweight, with a BMI of 14. This underweight state could have contributed to the development of the nocardiosis, or the alemtuzumab dosage might have been too high for a person weighing so little.
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After a treatment-free interval of 18 weeks, alemtuzumab was begun. Although the mononuclear cell subsets in the patient's blood were normal at the time of the first alemtuzumab infusion, it is possible that pretreatment with natalizumab contirubted to the risk of opportunistic infection. It has been suggested that an interval of up to 6 months should be provided between discontinuation of treatment with natalizumab and initiation of treatment with alemtuzumab. However, any "safety interval" longer than 3 months carries a definite risk of recurrence of activity of multiple sclerosis, especially after natalizumab.
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More on this:
http://www.medpagetoday.com/clinical-context/MultipleSclerosis/57171?xid=nl_mpt_DHE_2016-04-06&eun=g378374d0r (http://www.medpagetoday.com/clinical-context/MultipleSclerosis/57171?xid=nl_mpt_DHE_2016-04-06&eun=g378374d0r)