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Research paper
Alemtuzumab treatment of multiple sclerosis: long-term safety and efficacy
  1. Orla Tuohy1,
  2. Lisa Costelloe2,
  3. Grant Hill-Cawthorne3,
  4. Ingunn Bjornson1,
  5. Katharine Harding4,
  6. Neil Robertson4,
  7. Karen May1,
  8. Tom Button1,
  9. Laura Azzopardi1,
  10. Onajite Kousin-Ezewu1,
  11. Michael T Fahey5,
  12. Joanne Jones1,
  13. D Alastair S Compston1,
  14. Alasdair Coles1
  1. 1Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
  2. 2Department of Neurology, Beaumont Hospital, Dublin, Ireland
  3. 3Sydney Institute of Emerging Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
  4. 4Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, Wales, UK
  5. 5Biostatistics Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
  1. Correspondence to Dr Orla Tuohy, Department of Clinical Neurosciences, University of Cambridge, Box 165, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; oct21{at}cam.ac.uk

Abstract

Objectives Alemtuzumab is a newly licensed treatment of active relapsing-remitting multiple sclerosis (RRMS) in Europe, which in phase II and III studies demonstrated superior efficacy over β-interferon in reducing disability progression over 2–3 years. In this observational cohort study, we sought to describe our longer-term experience of the efficacy and safety of alemtuzumab in active RRMS.

Methods Clinical and laboratory data including serial Expanded Disability Status Scale (EDSS) assessments, from all 87 patients treated with alemtuzumab on investigator-led studies in Cambridge, UK, from 1999 to 2012, were collected. The occurrence of adverse events including secondary autoimmunity, malignancy and death, and pregnancy outcomes was recorded. Baseline variables including age, disease duration and relapse rate were compared in univariate and logistic regression analyses between groups with different disability outcomes.

Results Over a median 7-year follow-up (range 33–144 months), most patients (52%) required just two cycles of alemtuzumab. In the remaining patients, relapses triggered re-treatment to a total of three cycles (36%), four cycles (8%) or five cycles (1%). Using a 6-month sustained accumulation of disability definition, 59/87 (67.8%) of patients had an improved or unchanged disability compared with baseline. By an area under the curve analysis, 52/87 (59.8%) patients had an overall improvement or stabilisation of disability. Higher baseline relapse rate was associated with worse long-term disability outcomes, with trends for longer disease duration and older age at first treatment. Secondary autoimmunity was the most frequent adverse event occurring in 41/86 (47.7%) patients, most commonly involving the thyroid gland.

Conclusions Alemtuzumab is associated with disease stabilisation in the majority of patients with highly active RRMS over an average seven-year follow-up. No new safety concerns arose over this extended follow-up.

  • Multiple Sclerosis
  • Immunology

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