Alemtuzumab vs. Interferon

1
Alemtuzumab vs. Interferon ß-1a in Early Multiple
Sclerosis1

• Safety and Side Effects
• Patients experienced slightly more adverse events
  on alemtuzumab than interferon. This was almost
  entirely due to the mild or moderate symptoms
  associated with the infusion of alemtuzumab,
  typically headache and rash, which were
  controllable with simple measures.
• Infections were more common in the alemtuzumab
  group, however this was predominantly due to
  increased respiratory tract (upper and lower)
  infections rather than more serious opportunistic
  infections. Malignancy was balanced between the
  treatment arms after the study period in the
  alemtuzumab group there was a single case of
  leukaemia.
• The significant (common and potentially severe)
  complication of alemtuzumab treatment was
  autoimmunity. This was most frequently treatable
  hyper/hypo-thyroidism and less commonly immune
  thrombocytopaenic purpura (ITP). For one patient
  the ITP was fatal.

Figure 1
Addenbrookes Clinical Research Centre

• Introduction
• Multiple sclerosis (MS) is thought to be an
  autoimmune disease in which aberrant immune
  responses led by focal lymphocytic infiltrations
  cause damage of myelin and axons. It is the
  commonest potentially disabling disease of the
  central nervous system in the Western World.
• Alemtuzumab is a monoclonal antibody, humanised
  to reduce the potential for patients to develop
  an immune response against it, that targets CD52
  on lymphocytes and monocytes. It is currently
  licensed for the treatment of B-CLL and has been
  studied in patients with multiple sclerosis at
  Cambridge since 1991.
• This multicentre phase 2, randomised, rater
  blinded trial was of previously untreated
  patients with early relapsing-remitting multiple
  sclerosis. Disease activity was confirmed
  clinically (two or more relapses in the preceding
  2 years) and radiologically (one or more
  enhancing lesions on cranial magnetic resonance
  imaging).
• The control group was actively treated with
  interferon-ß. Two dose regimens of alemtuzumab
  were tested there was no difference between the
  two doses in the safety or outcome measures, so
  the alemtuzumab data are pooled.

Figure 2
Conclusions In early, untreated,
relapsing-remitting multiple sclerosis compared
to interferon Alemtuzumab suppresses relapse
rate by 74 figure1 Alemtuzumab reduces the rate
of fixed disability by 74 figure2 Alemtuzumab
improves mean disability figure3 As previously
described, adverse effects of alemtuzumab are
infusion reaction infections and
autoimmunity Phase 3 studies of alemtuzumab are
currently enrolling
Figure 3
University of Cambridge Neuroscience
1. The CAMMS223 Trial Investigators Alemtuzumab
vs. Interferon Beta-1a in Early Multiple
Sclerosis The New England Journal of Medicine
Vol. 3591786-1801 (October 23, 2008)
Poster prepared by T Button on behalf of CAMMS223
Trial Investigators PI AJ Coles, PI DAS
Compston