MS Speaks

Alemtuzumab for multiple sclerosis: Long term follow-up in a multi-centre cohort

MD Willis
Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, UK/Department of Neurology, University Hospital of Wales, UK

KE Harding
Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, UK/Department of Neurology, University Hospital of Wales, UK

TP Pickersgill
Department of Neurology, University Hospital of Wales, UK

M Wardle
Department of Neurology, University Hospital of Wales, UK

OR Pearson
Department of Neurology, Morriston Hospital, UK

NJ Scolding
Department of Neurology, Southmead Hospital, UK

J Smee
Department of Neurology, University Hospital of Wales, UK

NP Robertson⇑
Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, UK/Department of Neurology, University Hospital of Wales, UK
Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK.

Background:

Alemtuzumab has recently been approved for treatment of relapsing MS, but concerns remain about its use since long-term studies of adverse events remain limited. Furthermore, a clear understanding of its application and durability of effect in clinical practice has yet to evolve.

Objectives:

To investigate long-term efficacy and safety outcomes in a multicentre cohort of patients treated with alemtuzumab.

Methods:

Patients treated from 2000 and followed-up at three regional centres were identified. Baseline and prospective data were obtained and validated by clinical record review.

Results:

One hundred patients were identified with a mean follow-up of 6.1 years (range 1–13). Forty patients were retreated with at least one further treatment cycle. Annualized relapse rates fell from 2.1 to 0.2 (p<0.0001) post-treatment and were sustained for up to eight years of follow-up.

Mean change in EDSS score was +0.14. Forty-seven patients developed secondary autoimmunity.

Conclusion:

Observed reduction in relapse rates reflected those reported in clinical trials, but we were unable to corroborate previous observations of disability reversal. 40% of patients required additional treatment cycles.

Autoimmune adverse events were common, occurring at a higher rate than previously reported, but were largely predictable, and could be managed effectively within a rigorous monitoring regime.