Alemtuzumab in the treatment of multiple sclerosis: patient selection and special considerations

Figures & data

Table 1 Disease-modifying drugs approved for multiple sclerosis

Drug	Application	Mode of action	Common side effects
Interferon beta-1a/Peginterferon beta-1a/Interferon beta-1b	Intramuscular/subcutaneous	Pleiotrophic immunomodulatory cytokine	Flu-like symptoms, injection-site reactions, hepatopathy
Glatiramer acetate	Subcutaneous	Immunomodulatory polypeptide	Injection-site reactions, lipodystrophy
Teriflunomide	Oral	Reversible inhibition of dihydroorotate-dehydrogenase	Hepatopathy, gastrointestinal side effects, hair thinning
Dimethylfumarate	Oral	Activation of NrF 2 pathway (?), antioxidant (?)	Flush syndrome, gastrointestinal side effects, lymphopenia
Fingolimod	Oral	Sphingosine-1-phosphate receptor modulator	Infections, hepatopathy, bradyarrhythmia, gastrointestinal side effects
Natalizumab	Intravenous	mAb against α4β1-integrine	Opportunistic infections, gastrointestinal side effects, infusion- associated reactions
Alemtuzumab	Intravenous	mAB against CD52	Infections, infusion-associated reactions, secondary autoimmune disorders
Daclizumab	Subcutaneous	mAB against CD25	Infections, skin reactions, hepatopathy
Mitoxantrone	Intravenous	DNA intercalation, inhibition of DNA/RNA synthesis	Infections, gastrointestinal side effects, myelopsuppression, cardiotoxicity, secondary neoplasia

Note: “?” Highlights the hypothetical character of these risk factors.

Abbreviations: DNA, deoxyribonucleic acid; mAB, monoclonal antibody; NrF 2, nuclear factor 2 related factor; RNA, ribonucleic acid.

Figure 1 Algorithm for selection of patients eligible for alemtuzumab treatment.

Notes: The decision tree may help to decide whether a patient is a candidate for treatment with alemtuzumab. “?” Highlights the hypothetical character of these risk factors.
Abbreviations: BMI, body mass index; RMP, risk management plan.