Multiple Sclerosis: 5-Year Follow-Up Says Alemtuzumab Prevents Brain Volume Loss

It’s not uncommon for patients with multiple sclerosis (MS) to experience a reduction in brain volume. However, treatment with alemtuzumab can slow the process, according to a multi-continental team of investigators.

Two studies, CARE-MS I and CARE-MS II, analyzed the outcomes of alemtuzumab use – the first consisted of treatment-naïve patients and the second included those who relapsed on prior therapy. Frederik Barkhof, MD, PhD, from the VU University Medical Centre in Amsterdam presented the conclusions at the 31^st Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS 2015) in Barcelona, Spain.

All participants had relapsing-remitting multiple sclerosis (RRMS) and were treated actively for two years, then for up to four years after as needed.

“Most patients did not receive alemtuzumab retreatment after the initial two courses in the core study through year five,” Barkhof pointed out during the presentation. After just two years into the study, a “significant difference” was observed in the slowing of brain volume loss in CARE-MS II. Barkhof noted that even patients who dropped out of the studies early were showing similar results.

“We can see that there is a 42% slowing of atrophy,” he spoke on the CARE-MS I results. “Most people, as a group, have a favorable atrophy.” Patients in the second study, who had failed on a prior therapy, had an average slowing of brain volume loss by 24% on alemtuzumab.

“Median annual brain volume loss in both studies was ˂ 0.2% in years three, four, and five,” Barkhof verified. Notably, there were very low rates of atrophy during the final year of the trial – an outcome that Barkhof described as “very reassuring.” At the end of five years, those in CARE-MS I had an average brain volume loss progression of 1.2% – which is close to what is expected from normal aging.

 “Very few people needed retreatment,” Barkhof added. Retreatment rates were slightly higher in CARE-MS II participants, however, which could be due to the fact those patients had been treated before so their disease activity could be higher.

“Alemtuzumab slowed brain volume loss through year five in active RRMS patients who were treatment-native or had an inadequate response to prior therapy,” Barkhof confirmed.

An earlier presentation at the conference found that the drug significantly reduces relapse rate and this observation shows success in preventing brain volume loss over five years. Therefore, this analysis adds to the growing evidence that alemtuzumab has multiple uses in effectively combating multiple sclerosis.