Additional data on alemtuzumab use including clinical, imaging and safety outcomes in a real-world setting can improve patient care.
To examine clinical, imaging and safety outcomes in relapsing multiple sclerosis (MS) patients who received at least 2 courses of alemtuzumab.
This retrospective, single-center study included patients treated with at least 2 courses of alemtuzumab and at least 12 months of follow-up. Demographic, clinical (annualized relapse rate; disability progression); imaging characteristics (brain and spine MRI); previous treatment; co-morbidities and adverse events were analyzed. Patient data for 2 years prior to course 1 (index date) and for up to 4 years after initiation of alemtuzumab was available for all patients.
74 patients were included. Mean age (SD) at baseline was 41.8 (9.9), diagnosis duration 11.5 (7.8) years. 33 patients needed help with ambulation; of which 11 were wheelchair-bound. 45% of patients switched from natalizumab and 23% from fingolimod primarily due to MS worsening. After Alemtuzumab treatment, ARR was significantly decreased from 1.231 (1-year pre-) to 0.392 (1-year post-) index date (P < 0.0001) and to 0.313, 0.240 and 0.291 during each of following 3 years respectively. Comparing one year prior to and 2-years post- treatment: more patients had stable spinal cord MRI (94.3% vs 62.5%) and fewer showed worsening (37.5% vs 5.7%) (p = 0.0017). On brain MRI, more patients were stable (87.7% vs. 52.1%) and fewer patients showed worsening (48.0% vs. 9.6%) (p<0.0001). On disability, 69% of patients remained stable; 3 of 11 wheelchair-bound patients became ambulatory. Safety outcomes will be available for presentation.
This real-world data suggests alemtuzumab is clinically and radiographically safe and effective in a wide spectrum of MS patients including those with severe disability, longer disease duration and multiple comorbidities. Long term follow-up of this cohort will help assess the clinical efficacy of alemtuzumab in a real-world setting.