Multiple sclerosis alemtuzumab

Alemtuzumab Chronic lymphocytic leukaemia, multiple sclerosis... 

Nine of 27 patients with multiple sclerosis developed antibodies against the thyrotropin receptor and carbima-zole-responsive autoimmune hyperthyroidism after a 5-day pulse of alemtuzumab, a finding that was not reported in patients treated for other disorders (18). 

Alemtuzumab (campath-lH) is a humanized monoclonal antibody specific for the CDw52 antigen, present on cell membranes of lymphocytes and monocytes. It has been used for treatment of patients with rheumatoid arthritis and vasculitis, is being investigated for the treatment of chronic lymphocytic leukemia, and has been used to deplete circulating lymphocytes in patients with multiple sclerosis (1). In 2001, alemtuzumab was approved in Europe for the treatment of chronic B cell lymphocytic leukemia that had been treated previously with alkylating agents and was refractory to fludarabine (2). It has also been used for induction of immunosuppression/tolerance in liver transplant recipients (3,4) and kidney/pancreas transplant recipients (5). 

Uses Alemtuzumab is indicated for the treatment of patients with B-cell chronic lymphocytic leukemia for whom fludarabine combination chemotherapy is not appropriate. Alemtuzumab may also be effective in early multiple sclerosis [138 ], as induction therapy before transplantation [139 140 ], and in vasculitis associated with anti-neutro-phil cytoplasmic antibodies (ANCA) [141 ]. 

Nervous system Infusion-related headache affected more than 50% of treated individuals in a cohort of patients with multiple sclerosis [138 ]. Anxiety, syncope, vertigo, dizziness, tremor, paresthesia, and hypesthe-sia are common undesirable reactions during treatment or within 30 days after the completion of treatment with alemtuzumab. Guil-lain-Barre syndrome and its chronic form, chronic inflammatory demyelinating polyradiculoneuropathy, have also been reported. 

Liver There were abnormal liver function tests in 2.3% of patients with multiple sclerosis treated with alemtuzumab [138. ... 

Skin Infusion-related rashes affected more than 90% of treated patients with multiple sclerosis [138 ]. Urticaria is one of the commonest types of rash during alemtuzumab therapy. 

Infection risk Recurrent oral herpes simplex virus type 1 was seen in 1.4% of patients with multiple sclerosis immediately after each cycle of alemtuzumab [138 ]. Inactive tuberculosis was incidentally identified in one patient who received alemtuzumab 24 mg. There were no cases of progressive multifocal leukoencephalo-pathy, cytomegalovirus infection, or pneu-mocystis pneumonia. 

The CAMMS223 Trial Investigators. Alemtuzumab vs. interferon beta-la in early multiple sclerosis. N Engl J Med 2008 359(17) 1786-801. 

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