Alemtuzumab is recommended for the treatment of 'active' relapsing MS. This has been defined in guidelines as when you have two or more relapses in the last two years. But more and more MS specialists are defining 'active' MS as one recent relapse and/or signs on MRI scans that MS is active.
- You can take alemtuzumab if you have relapsing MS and you've had a relapse in the last year and MRI scans show new signs that your MS is active (you have new lesions) despite taking another DMT
- Alemtuzumab can be used more widely as a person's first DMT. But this is only if they've had a recent relapse and/or MRI scans show new signs that their MS is active (they have new lesions). In these cases it can be used whether people have tried another DMT or not.
Alemtuzumab was originally developed to treat certain types of leukaemia and lymphoma (cancers of the immune system). It binds to and kills white blood cells (immune cells), stopping them from entering the brain and attacking the myelin covering around the nerves that protects them (which is the cause of damage in MS).
Most people take the drug 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.
MS drugs can be put into three groups based on how well they control it. Alemtuzumab is in the 'highly effective' group (the best group). This is based how how much it reduces relapses and slows down the rate at which people's disability gets worse. Alemtuzumab is significantly more effective than standard MS treatment with beta interferons.
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 trials, 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).
But in one 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?
Some of the more common, mild and short lived side effects are headaches, rash, feeling sick, hives (a skin rash), fever, itching, going red in the face and neck, and feeling tired. Other side effects include cold sores and infections of your chest, throat, urinary tract and sinuses (the spaces around your nose).
There have been more serious side effects reported with alemtuzumab, such as developing an overactive or underactive thyroid. These problems are treatable but need lifelong medication.
There's also a very small risk of developing a blood clotting disorder known as ITP (immune thrombocytopenia). It’s potentially very serious but treatable if it’s caught early by a blood test.
Everyone taking alemtuzumab will have tests for side effects for four years after their last infusion. They'll be monitored for problems relating to the thyroid and ITP. 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 either problem.