J Clin Neurol.  2019 Jul;15(3):328-333. 10.3988/jcn.2019.15.3.328.

Therapeutic Outcome of Alemtuzumab in Korean Patients with Multiple Sclerosis: 2-Year Follow-Up

Affiliations
  • 1Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea. hojinkim@ncc.re.kr

Abstract

BACKGROUND AND PURPOSE
Alemtuzumab has shown high efficacy in clinical trials that primarily involved Western multiple sclerosis (MS) patients. To evaluate the therapeutic outcome of alemtuzumab in Korean patients with MS.
METHODS
This study enrolled 23 consecutive patients who were treated with alemtuzumab from 2015 to 2018. Efficacy was evaluated using the annualized relapse rate (ARR), Expanded Disability Status Scale (EDSS), and radiological activity. No evidence of disease activity (NEDA) was defined as no clinical relapse, no worsening of the EDSS score, and no radiological activity. The safety profiles were also assessed.
RESULTS
The mean age was 36 years and 16 of the patients were female. Seventeen and 12 of 23 patients were followed up for 1 year and 2 years, respectively. The ARR was markedly reduced from 1.52 during the 1-year period preceding alemtuzumab administration to 0.21 after initiating alemtuzumab (p<0.001). During the first and second years after initiating alemtuzumab, EDSS worsening was observed in 3 (18%) and 0 (0%) patients, respectively, and radiological activity was exhibited in 9 (53%) and 4 (33%). NEDA was observed in 6 (35%) patients during the first year and in 8 (67%) patients during the second year. Intriguingly, one patient experienced 2 severe clinical exacerbations, which occurred at 10 months after the first and 10 months after the second infusion of alemtuzumab. Nineteen of the 23 patients exhibited infusion-associated reactions and 3 patients exhibited herpes zoster infection. Thyroid dysfunction occurred in two patients at 18 and 20 months after initiating alemtuzumab.
CONCLUSIONS
Consistent with observations in Western populations, alemtuzumab therapy in Korean MS patients led to marked reductions of disease activity without unexpected safety issues.

Keyword

multiple sclerosis; alemtuzumab; efficacy; safety

MeSH Terms

Female
Follow-Up Studies*
Herpes Zoster
Humans
Multiple Sclerosis*
Recurrence
Thyroid Gland

Figure

  • Fig. 1 One-year pretreatment and posttreatment ARRs during 2 years of follow-up in patients with multiple sclerosis receiving alemtuzumab. ARR: annualized relapse rate.

  • Fig. 2 Worsening of the score on the Expanded Disability Status Scale after initiating alemtuzumab during 2 years of follow-up.

  • Fig. 3 Radiological activity status during 2 years of follow-up after initiating alemtuzumab.

  • Fig. 4 No evidence of disease activity during 2 years of follow-up after initiating alemtuzumab.


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