Intractable and highly active relapsing multiple sclerosis – role of alemtuzumab

Figures & data

Figure 1 Alemtuzumab-mediated cytolysis and apoptosis of T- and B-lymphocytes.

Abbreviations: ADCC, antibody-dependent cell-mediated cytotoxicity; CDC, complement-dependent cytotoxicity; MAC, membrane attack complex; FcγR, Fc-gamma receptor.

Table 1 Depicting the summary of study end points and major adverse effects of the randomized control trial

	CAMMS223^Citation32	CAMMS223 extension^Citation35	CARE-MSI^Citation33	CARE-MSII^Citation34
Study design	Single-blind, randomized	Single-blind, randomized	Single-blind, randomized	Single-blind, randomized
Active comparator	INF-β1a	INF-β1a	INF-β1a	INF-β1a
Number of patients	Alem: 222	Alem: 151	Alem: 376	Alem: 426
	INF-β1a: 112	INF-β1a: 47	INF-β1a: 205	INF-β1a: 241
Duration of follow-up, months	36	60	24	24
Relapse rate reduction by Alem	74% (P<0.001)	69% (P<0.0001)	55% (P<0.0001)	49% (P<0.0001)
Mean change in EDSS	Alem: −0.39	Alem: −0.30	Alem: −0.14	Alem: −0.17
	INF-β1a: +0.38;	INF-β1a: +0.46;	INF-β1a: −0.14;	INF-β1a: +0.24;
	P<0.001	P<0.001	P=0.97	P<0.001
Clinically disease-free patientsa	Alem: 72%	NA	Alem: 74%	Alem: 60%
	INF-β1a: 43%;		INF-β1a: 56%;	INF-β1a: 41%;
	P<0.001		P<0.0001	P<0.0001
New T1 contrast-enhancing lesiona	NA	NA	Alem: 9%	Alem: 9%
			INF-β1a: 19%;	INF-β1a: 23%;
			P<0.0001	P<0.0001
New or enlarging T2 lesionsa	NA	NA	Alem: 48%	Alem: 46%
			INF-β1a: 58%;	INF-β1a: 68%;
			P=0.04	P<0.0001
MRI and clinically disease freea	NA	NA	Alem: 39%	Alem: 32%
			INF-β1a: 27%;	INF-β1a: 14%;
			P=0.006	P<0.0001
ITPa	Alem: 2.8%	Alem: 2.8%	Alem: 0	Alem: 0
	INF-β1a: 0.9%	INF-β1a: 0.9%	INF-β1a: 1%	INF-β1a: 1%
Thyroid-related adverse effectsa	Alem: 22.7%	Alem: 29.6%	Alem: 18%	Alem: 16%
	INF-β1a: 2.8%	INF-β1a: 3.7%	INF-β1a: 6%	INF-β1a: 5%
Goodpasture syndromea	Alem: 0	Alem: 0.7%	Alem: 0.3%	Alem: 0
	INF-β1a: 0	INF-β1a: 0	INF-β1a: 0	INF-β1a: 0
Malignancies	Alem: 3 (1 colon CA, 1 breast CA, and 1 Burkitt lymphoma) INF-β1a: 1 (colon CA)	Alem: 3 (1 thyroid papillary CA and 2 basal cell CA) INF-β1a: 0	Alem: 2 thyroid papillary cancers INF-β1a: 0	Alem: 2 (1 basal cell CA and 1 AML) INF-β1a: 2 (1 basal cell CA and 1 thyroid CA)

Note:

a Reported as percentage of patients.

Abbreviations: INF-β1a, interferon-β1a; Alem, alemtuzumab; EDSS, expanded disability status scale; NA, not available; MRI, magnetic resonance imaging; ITP, idiopathic thrombocytopenic purpura; CA, cancer; AML, acute myeloid leukemia.

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