Serious adverse effect with alemtuzumab reported
medwireNews: Researchers have highlighted the occurrence of severely exacerbated central nervous system (CNS) inflammation in two patients taking alemtuzumab for multiple sclerosis (MS).
The two patients had highly active disease and were started on alemtuzumab having experienced relapses despite numerous different treatments.
After approximately 6 months, however, both patients experienced a significant worsening of their symptoms and were admitted to hospital. Magnetic resonance imaging (MRI) showed several new contrast-enhancing lesions, many of which were ring-enhancing. This differed from the patients’ previous disease pattern.
“The exacerbated inflammation seen in our patients is consistent with the time frame in which B-cell repopulation and peripheral expansion occur following alemtuzumab treatment,” observe Ralf Gold (Ruhr-University Bochum, Germany) and fellow clinicians in a letter to The Lancet Neurology.
“Thus, it remains to be determined if the disease observed in these patients after treatment is due to worsening of multiple sclerosis or to the development of secondary CNS-directed autoimmunity.”
Both cases improved following plasmapheresis and treatment with the B-lymphocyte antibody rituximab, including recession of ring-shaped lesions, and were stable 9–12 months later.
They note that whole genome analysis ruled out a rare genetic or infectious etiology and so it is possible that further cases may occur.
The team therefore concludes that “apparent relapses after alemtuzumab treatment should be promptly evaluated by MRI for the presence of ring-enhancing lesions.
“A specific rescue therapy comprising plasma exchange with consecutive B-cell depletion can then be initiated to help prevent irreversible disability.”
By Lucy Piper
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