Alemtuzumab for multiple sclerosis

Evidence Summaries

Level of Evidence = A
Alemtuzumab is better than interferon beta-1a for relapse-free survival, sustained disease progression-free survival and MRI lesions at 24 months in multiple sclerosis. However, adverse events are more common for alemtuzumab.

A Cochrane review 1 included 3 studies with a total of 1713 subjects with multiple sclerosis (MS). The trials compared alemtuzumab vs. s.c. interferon beta-1a (IFN) for patients with relapsing–remitting MS. Patients were treatment-naive in two studies, the third study included patients with at least one relapse while being treated with IFN beta or glatiramer acetate. Alemtuzumab was given for 12 or 24 months; for some outcomes, the follow-up period reached 36 months. The regimens were (a) 12 mg or 24 mg per day administered iv., once a day for 5 days at month 0 and 12 or (b) 24 mg per day, iv., once a day for 3 consecutive days at month 12 and 24. The patients in the other arm of the trials received sc. IFN beta.

  • At 24 months: alemtuzumab 12 mg was associated with: (a) higher relapse-free survival (HR 0.50, 95% CI 0.41 to 0.60; 2 studies, n=1248); (b) higher sustained disease progression-free survival (HR 0.62, 95% CI 0.44 to 0.87; 2 studies, n= 1191); (c) a slightly higher number of participants with at least one adverse event (RR 1.04, 95% CI 1.01 to 1.06; 2 studies, n=1248); (d) a lower number of participants with new or enlarging T2-hyperintense lesions on MRI (RR 0.74, 95% CI 0.59 to 0.91; 2 studies, n= 1238); and (e) a lower number of dropouts (RR 0.31, 95% CI 0.23 to 0.41; 2 studies, n=1248).
  • At 36 months: alemtuzumab 24 mg was associated with: (a) higher relapse-free survival (45 vs. 17; HR 0.21, 95% CI 0.11 to 0.40; one study, n=221); (b) a higher sustained disease progression-free survival (HR 0.33, 95% CI 0.16 to 0.69; one study, n=221); and (c) no statistical difference in the rate of participants with at least one adverse event. No studies reported rate of participants free of clinical disease activity, quality of life, fatigue or change in the numbers of MRI T2- and T1-weighted lesions after treatment.

References

1. Riera R, Porfírio GJ, Torloni MR. Alemtuzumab for multiple sclerosis. Cochrane Database Syst Rev 2016;4():CD011203.  [PMID:27082500]


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