Who can take alemtuzumab?
In Scotland, Northern Ireland and Wales you can have alemtuzumab if:
- you've got relapsing MS and, despite taking another DMT, you've had a relapse in the past year and MRI scans show new signs (lesions) that your MS is active (you have new lesions)
- or, whether you’ve already had another DMT or not, you’ve had a recent relapse and/or MRI scans show new signs that your MS is active
You’re usually offered this drug only if:
- despite taking another DMT, you’ve had a relapse in the last year or MRI scans show new signs that your MS is active (you have new lesions)
You might be offered alemtuzumab as your first DMT if you meet one of the following conditions:
- you’ve had two relapses in the last two years
- or you’ve had two or more relapses in one year and MRI scans show new signs that your MS is active (you have new lesions)
- or you’ve had a relapse in the last two years and MRI scans show new signs that your MS is active (two or more new lesions have appeared over a year)
In rarer circumstances you might be offered alemtuzumab in England if you’ve had a recent relapse and/or MRI scans show new signs that your MS is active.
How does alemtuzumab work?
Alemtuzumab kills certain types of cells made by your immune system. Called T and B cells they normally attack viruses and bacteria that get into your body. But in MS these cells attack the covering (called myelin) around the nerves in your brain and spinal cord. Alemtuzumab stops these cells from getting into your brain and spinal cord before they can damage the nerves there.
Most people only need to take the drug twice, in two courses spaced a year apart from each other. It's given through a drip (known as an infusion) in hospital.
For the first course you go to hospital five days in a row. Each day you have an infusion that takes about four hours. You might go home every day two hours after your infusion or you may stay in hospital for the length of the treatment.
You have the second course a year later, over three days in a row, again for about four hours each day. Most people don't need treating again but some might need a third (or even fourth) course. Again, this will be over three days in a row, for about four hours each day.
How well does alemtuzumab work?
MS drugs can be put into three groups based on how well they control it. The effect alemtuzumab has in controlling MS is classed as 'high', the best of the three groups. This is based on how much it reduces relapses and slows down the rate at which people's disability gets worse.
Relapses dropped by:
50-55% compared to beta interferons
This means that in trials, on average, people saw a 50-55% drop in the number of relapses they had (compared to people who took beta interferons).
Disability getting worse was slowed down by:
up to 42% compared to beta interferons
This means that in one trial, on average, people saw a drop of up to 42% in the risk of their disability getting worse (compared to people who took beta interferons).
In another trial people taking alemtuzumab saw a drop in the risk of their disability getting worse of 30%. But this wasn't big enough to be 'significant'. In other words, it could've happened by chance and not because of the drug.
What are the side effects of alemtuzumab?
Compared to other MS drugs the risk of side effects, especially serious ones, is among the highest.
Side effects include infections of your chest, throat, urinary tract and sinuses (the spaces around your nose). After an infusion most people get one or more of these: headaches, rash, hives (a skin rash), feeling or being sick, fever, itching, going red in the face and neck, and feeling tired. These usually soon go away.
More serious side effects include developing a thyroid problem (up to four in 10 people get this). It's treatable but needs lifelong medication. You can still keep taking alemtuzumab.
One to three people in a hundred get a problem with their blood called ITP (immune thrombocytopenia). It can be very serious but it's treatable if caught early by a blood test. Symptoms include bruising and bleeding too easily.
A very rare side effect can happen within a day or so of starting this drug. Less than one in a thousand people have a stroke or blood vessels in their neck or head tear. This can cause people to become permanently disabled or die.
Everyone who's taken alemtuzumab will have tests for side effects for four years after their last infusion. They'll be monitored for problems with their thyroid and blood. Your health care team should also tell you what to look out for and what to do if you notice any signs or symptoms of these problems.