Treatment with Alemtuzumab Might Be ‘Resetting' the Immune System in Patients with Relapsing-Remitting Multiple Sclerosis

Anthony Traboulsee, MD, is an associate professor at the University of British Columbia and director of the UBC Hospital in Vancouver, Canada, where his clinic sees 5,000 MS patients. But he didn’t get there by himself.

One of the world’s most famous MS doctors, the late Donald Paty, mentored him and said, “Tony, make sure you do some research to keep hope alive.” The neurologist says research lets you know what’s around the corner and you get to be the first one to work with it. Patients get early access to experimental drugs in phase II and phase III trials. People tend to get nervous about new medications because they don’t want to be guinea pigs. But if you do well on the new medication, Traboulsee says to stay on it, assuming it’s safe.

Now that he’s managed a trial of 80 patients on Lemtrada (alemtuzumab), Traboulsee believes the future of MS is very treatable. He says the idea behind the drug is that patients could just have to do two rounds of treatment, then nothing for another two years.

Traboulsee believes he’s part of a movement that’s 10 years ahead of the curve and thinks this treatment might be resetting the immune system in patients who receive it.

At the 2015 Annual Meeting of the Consortium of Multiple Sclerosis Centers in Indianapolis, Indiana, he shared that in his study, the majority of patients on Lemtrada remained free of new MRI activity in year 4 of the study, with most receiving their last treatment 3 years earlier. And the rate of brain atrophy stayed low in year 4, with a median yearly brain volume loss of less than 0.2 percent in the third and fourth years.

These results show that treatment with Lemtrada reduces focal inflammation. The durable effects may be due to the distinct pattern of lymphocyte depletion and repopulation after treatment.

Traboulsee explained that during treatment when “fixing” MS auto-immunity, 30 percent of patients develop a thyroid problem, albeit one that most would prefer.

He also said that there is a growing philosophy to “nip it in the bud.” Many neurologists believe when treatment begins in the early stages of MS, progression may be prevented.

He advised primary care physicians to remember that the sooner a patient starts treatment, the sooner they may have a normal life. This requires early diagnosis and referral to an MS specialist. The time to intervene is before the patient has physical problems, needing a walker or wheelchair. “Even specialists can’t fix that,” he said.

“If you’re comfortable with infusions, Lemtrada can be a nice option for relapsing-remitting MS patients,” said Traboulsee.