title: Alemtuzumab for multiple sclerosis: Long term follow-up in a multi-centre cohort.
abstract: Alemtuzumab has recently been approved for treatment of relapsing MS, but concerns remain about its use since long-term studies of adverse events remain limited. Furthermore, a clear understanding of its application and durability of effect in clinical practice has yet to evolve.
  
  
  
  To investigate long-term efficacy and safety outcomes in a multicentre cohort of patients treated with alemtuzumab.
  
  
  
  Patients treated from 2000 and followed-up at three regional centres were identified. Baseline and prospective data were obtained and validated by clinical record review.
  
  
  
  One hundred patients were identified with a mean follow-up of 6.1 years (range 1-13). Forty patients were retreated with at least one further treatment cycle. Annualized relapse rates fell from 2.1 to 0.2 (p<0.0001) post-treatment and were sustained for up to eight years of follow-up. Mean change in EDSS score was +0.14. Forty-seven patients developed secondary autoimmunity.
  
  
  
  Observed reduction in relapse rates reflected those reported in clinical trials, but we were unable to corroborate previous observations of disability reversal. 40% of patients required additional treatment cycles. Autoimmune adverse events were common, occurring at a higher rate than previously reported, but were largely predictable, and could be managed effectively within a rigorous monitoring regime.
authors.affiliation: Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, UK/Department of Neurology, University Hospital of Wales, UK.
authors.forename: M D
authors.initials: MD
authors.lastname: Willis
authors.affiliation: Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, UK/Department of Neurology, University Hospital of Wales, UK.
authors.forename: K E
authors.initials: KE
authors.lastname: Harding
authors.affiliation: Department of Neurology, University Hospital of Wales, UK.
authors.forename: T P
authors.initials: TP
authors.lastname: Pickersgill
authors.affiliation: Department of Neurology, University Hospital of Wales, UK.
authors.forename: M
authors.initials: M
authors.lastname: Wardle
authors.affiliation: Department of Neurology, Morriston Hospital, UK.
authors.forename: O R
authors.initials: OR
authors.lastname: Pearson
authors.affiliation: Department of Neurology, Southmead Hospital, UK.
authors.forename: N J
authors.initials: NJ
authors.lastname: Scolding
authors.affiliation: Department of Neurology, University Hospital of Wales, UK.
authors.forename: J
authors.initials: J
authors.lastname: Smee
authors.affiliation: Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, UK/Department of Neurology, University Hospital of Wales, UK RobertsonNP@cardiff.ac.uk.
authors.forename: N P
authors.initials: NP
authors.lastname: Robertson
mesh_terms: D000328:Adult; D000074323:Alemtuzumab / Q000009:adverse effects / Q000627:therapeutic use*; D015551:Autoimmunity / Q000187:drug effects; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D011446:Prospective Studies; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D000074323:Alemtuzumab
keywords: Multiple sclerosis; alemtuzumab; autoimmunity