For more than a year, the monoclonal antibody Lemtrada® (Alemtuzumab) has been approved in Germany for the treatment of relapsing MS. Although the study data indicates it is a very effective MS therapy, the drug is still a relatively unknown substance.Why is that? In my view, the efficacy data of Lemtrada® is convincing. Compared to Rebif®, a significant reduction in the relapse rate was achieved, especially in patients who had previously undergone therapy, and the progression of disability in more than two-thirds of patients has been significantly delayed over an observation period of 4 years. In about one third of the patients, a lasting improvement in the degree of disability has even been found.
This could be related to the special mechanism of action of Lemtrada®. The antibody leads to a long-lasting destruction of immune cells – particularly T cells, which play an important role in the development of MS. It is thought that when the immune system recovers – we talk about reconstitution – it may return to a different level and act less aggressively. This hypothesis has not yet been proven, but there is hope that the disease can be influenced long-term by the drug. The prerequisite for this is to start treatment early.
Despite these interesting considerations, many doctors and patients do not consider Lemtrada® as a treatment option – especially for more active disease courses – or do not want to consider it. This may be due to the extensive side effects reported for Lemtrada®. These start with infusion reactions that are generally expected, an increased susceptibility to infections that scares many patients, and the occurrence of autoimmune diseases, mainly of the thyroid and blood-forming system, which also increase the fear of the drug – the term “devil’s stuff” is often heard.
I see this more relaxed and am ultimately glad that Lemtrada® provides another option to effectively treat active disease courses. Of course, in this category of very effective drugs, there is “no such thing as a free lunch”. But the real side effects are ultimately quite predictable.
The infusion reactions are – contrary to reports from clinical studies – rather mild and easy to treat. With appropriate pre-medication, there are hardly any problems.
Indeed, we have observed that patients are more susceptible to infections 1 – 2 months after the infusion. Here one should pay close attention to possibly support the healing process of such an infection.
The autoimmune phenomena that can occur in the course of treatment are easy to detect with regular monitoring and can then also be treated. However, it is necessary for the doctor and patient to strictly adhere to the monitoring guidelines.
Note: Information on the mode of action of Alemtuzumab can be found at www.amsel.de/multimedia/MS treat.
