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Immunosuppression Has Benefits in Early Multiple Sclerosis

Alemtuzumab reduces relapse and disability but with substantial side effects

WEDNESDAY, Oct. 22 (HealthDay News) -- Aggressive immunosuppressive treatment with alemtuzumab greatly reduces the rate of relapse and disability in patients with early multiple sclerosis compared with interferon beta-1a, though with substantial adverse effects, according to a report in the Oct. 23 issue of the New England Journal of Medicine.

Alasdair J. Coles, Ph.D., from the University of Cambridge in the United Kingdom, and colleagues randomly assigned 334 untreated patients with early multiple sclerosis (Expanded Disability Status Scale scores of 3.0 or less and disease duration of three years or less) to 44 micrograms of subcutaneous interferon beta-1a three times a week or intravenous cycles of 12 or 24 mg alemtuzumab per day for 36 months.

Alemtuzumab treatment was suspended after three patients developed immune thrombocytopenic purpura and one died, the report indicates. The researchers found that alemtuzumab was significantly more effective than interferon beta-1a in reducing the rate of sustained accumulation of disability (9 percent versus 26.2 percent), reducing the annualized rate of relapse (0.10 versus 0.36) and improving the mean disability score (0.39 point increase versus 0.38 point decrease on a 10-point scale). As determined by T2- and T1-weighted MRI, alemtuzumab was also significantly more effective in reducing lesion burden and increasing brain volume. Outcomes were similar for both alemtuzumab doses. However, alemtuzumab treatment was also associated with autoimmunity (largely thyroid disorders), immune thrombocytopenic purpura, and infections, the authors note.

"The data convincingly demonstrate that intensive immunosuppression can dramatically reduce the accumulation of new inflammatory lesions and focal scarring and the rate of clinical relapse in patients with recent-onset multiple sclerosis," Stephen L. Hauser, M.D., from the University of California San Francisco, writes in an accompanying editorial. "It is evident that protection by alemtuzumab against relapse comes at a substantial price."

The study was supported by Genzyme and Bayer Schering Pharma, and several study authors and the editorial author report financial ties to those and/or other pharmaceutical companies.

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