Alemtuzumab reduces disability in patients with MS

A drug used to treat multiple sclerosis (MS) can reverse some of the physical disabilities created by the neurological disease, according to new research.

In the two-year study, people with relapsing-remitting MS who did not adequately respond to at least one other MS drug were treated with either alemtuzumab or interferon beta-1a. The results show that those given alemtuzumab were more likely to see improvements in pre-existing disabilities.

“This is big news for patients with MS,” says lead researcher Gavin Giovannoni, professor of neurology at Barts and The London School of Medicine and Dentistry, Queen Mary University of London. “In the first one or two years, a third of patients [taking alemtuzumab] not only stabilised but saw improvements in their disability. That [trend] goes up beyond two years to 40% of patients.”

Reporting their findings in Neurology
^[1]
(online, 12 October 2016), the researchers point out that previous studies have shown that disease-modifying therapies approved for relapsing-remitting MS can slow down progress of the disease but there have been few data illustrating their potential to restore physical ability.

“For the first time we are able to tell patients not just about stability in their disease but improved outcomes,” adds Giovannoni. “We aren’t talking about patients being back to normal, but we are talking about improved function.”

The study involved 628 patients, all with relapsing-remitting MS who had failed to respond well to at least one previous MS treatment. The researchers assigned 426 patients to alemtuzumab while 202 received interferon beta-1a.

Patients’ disability was assessed at the beginning of the trial and again at three-monthly intervals for two years.

The researchers found nearly 28% of patients in the alemtuzumab group had improved their disability score by at least 1 point at the end of the trial, with scores ranging from 0 to 10. They also found that disability scores improved in 15% of patients given interferon.

The alemtuzumab patients were more likely to achieve an improvement in their thinking skills compared with patients given interferon (odds ratio [OR] 2.54, 95% confidence interval [CI] 1.76-3.69; P<0.0001)). Patients given alemtuzumab were also more likely to see an improvement in being able to move without tremor or clumsy movements, known as ataxia (OR 2.26, CI 1.60-3.20; P<0.0001).

Giovannoni says if the benefits of alemtuzumab are confirmed in further trials, more research will be required to consider known risks associated with the drug, such as serious autoimmune problems and infusion reactions.

Amy Bowen, director of service development at the MS Trust, a UK-based charity that provides information on MS to health professionals and funds MS research, says: “It is encouraging to see evidence that a disease-modifying drug can show improvement in levels of disability, rather than just slowing or preventing further progression.”

Bowen also welcomes the researchers’ approach to their study, which she describes as “a more holistic understanding of disability” — the team looked at upper limb function and cognition, as opposed to just mobility.

The authors of an editorial^[2]
accompanying the study acknowledge that there has been “unarguable progress” in MS therapeutics.

However, they point out: “Even though cumulative evidence indicates that alemtuzumab is one of the strongest MS-modifying treatments currently available, it is not curative.”

They add that there is “a long road ahead” until disease progression can be eliminated for all patients.

Sanofi Genzyme and Bayer HealthCare Pharmaceuticals, co-developers of alemtuzumab, supported the study.

Alemtuzumab was recommended for NHS use in patients by the National Institute for Health and Care Excellence in May 2014.