Alemtuzumab (Lemtrada)

Alemtuzumab (trade name Lemtrada) is a disease modifying drug (DMD) available since 2014, and licensed for use in the treatment of active relapsing remitting MS and very active relapsing remitting MS. 

Lemtrada is a DMD for active and very active RRMS and is prescribed as a course of two treatments, 12 months apart, and reduces relapse rates by 70% compared to placebo.  It may also slow long-term disability progression.

It is given as an intravenous infusion, over five consecutive days in the first year, and then over three days in the second year. This is usually done in hospital, over a four-hour period each day. It may be necessary to have a third, or even fourth course of Lemtrada (up to 50%).

Lemtrada is designed to recognise and destroy certain types of white blood cells (B and T lymphocytes) thought to be involved when the immune system mistakenly attacks myelin. It is thought that the new B and T cells that are made then do not attack myelin.  Some think of it as like “restarting your computer” for the immune system.

Pregnancy and Breastfeeding: 

Current guidance recommends waiting for 4 months after a course of Lemtrada before trying to conceive. It is not advised to have a course of Lemtrada while breastfeeding.

Side Effects:

Infusion-related reactions are common, and include headache, rash, fever, nausea and fatigue. Generally these side effects are short-term and mild. Those receiving Lemtrada are often given antihistamines and steroids at the time of the infusion to prevent them.

As Lemtrada will suppress the immune system for a time after treatment, people are at increased risk of infections, such as colds, respiratory infections and viruses like cold sores and shingles.  Medications may be prescribed at the time of treatment to try and minimise these risks. 

More serious side effects arise from “secondary auto-immunity”, affecting up to one third of those treated with Lemtrada.  Instead of attacking myelin, as the immune system regrows it can attack other areas in the body, and lead to other autoimmune disorders.  These include;

  • Overactive or underactive thyroid gland
  • Goodpasture’s syndrome, an autoimmune disease of the kidney
  • Idiopathic thrombocytopenic purpura (ITP), a disorder where the blood is unable to clot as effectively, due to platelets being destroyed

These conditions are potentially serious, but usually treatable if detected early. 

Due to these risks, monthly blood testing is required for four years from the date of your last infusion.  

Further research is ongoing, aiming to reduce the risks of developing auto-immune side effects following Lemtrada.

On 12th April 2019, the European Medicines Agency recommended a temporary restriction on the use of Lemtrada.  This action was taken following new reports of rare, but potentially serious side effects affecting the immune system, liver, heart and blood vessels.

As a temporary measure, Lemtrada should only be used when MS remains highly active despite the use of TWO other disease modifying drugs, or where other drugs cannot be used.

If you have started Lemtrada, or are due to receive further treatment, you should continue with the medication.  Anyone treated should continue with the monthly blood and urine testing for four years from the date of the last infusion.

If you have concerns, you should discuss these with your neurologist or MS nurse.

Page last updated 18 April 2019 


References

  1. https://doi.org/10.1016/S0140-6736(12)61768-1
  2. https://doi.org/10.1212/WNL.0000000000004354
  3. http://dx.doi.org/10.1136/practneurol-2018-002060
  4. https://www.ema.europa.eu/en/documents/referral/lemtrada-article-20-referral-use-multiple-sclerosis-medicine-lemtrada-restricted-while-ema-review_en.pdf
Alemtuzumab (Lemtrada)