Epub ahead of print: Button et al. Magnetization transfer imaging in multiple sclerosis treated with alemtuzumab. Mult Scler. 2012 Apr 5.
The magnetization transfer ratio reflects the integrity of tissue
structure, including myelination and axonal density. Mean magnetization
transfer ratio fell in 18 untreated MSers both in normal appearing grey (-0.25 pu/year, p < 0.001) and white
matter (-0.12 pu/year, p = 0.004). Conversely, mean magnetization
transfer ratio was stable in 20 alemtuzumab-treated patients (grey
matter: -0.01 pu/year, p = 0.87; white matter: -0.02 pu/year, p = 0.51).
The gradient difference in grey matter was 0.25 pu/year (p < 0.001)
after age-adjustment. These data suggest that in multiple sclerosis alemtuzumab protects against tissue damage in normal-appearing grey matter, perhaps by preventing new lesion formation.
structure, including myelination and axonal density. Mean magnetization
transfer ratio fell in 18 untreated MSers both in normal appearing grey (-0.25 pu/year, p < 0.001) and white
matter (-0.12 pu/year, p = 0.004). Conversely, mean magnetization
transfer ratio was stable in 20 alemtuzumab-treated patients (grey
matter: -0.01 pu/year, p = 0.87; white matter: -0.02 pu/year, p = 0.51).
The gradient difference in grey matter was 0.25 pu/year (p < 0.001)
after age-adjustment. These data suggest that in multiple sclerosis alemtuzumab protects against tissue damage in normal-appearing grey matter, perhaps by preventing new lesion formation.
“It looks as if Alemtuzumab is neuroprotective. This is a very important observation and if confirmed will be very good news for MSers and more evidence to support early aggressive treatment to prevent gray matter damage.”
CoI: multiple
I understand from the 5 year Follow-up study (Coles et Al, March 2012) that Alemtuzumab cuts down ARR by 69% and disease progression by 72% over interferon beta.Am I right to assume that Natalizumab has a similar ARR rate but a disease progression slow-down of 42% over placebo?All risks on the side, isn't Alemtuzumab significantly better that the best drug in the market? If so, why isn't it available yet?
Re: "All risks on the side, isn't Alemtuzumab significantly better that the best drug in the market? If so, why isn't it available yet?"You are quoting the phase 2 results, which were done in a highly active cohort. Natalizumab reduces the ARR by >80% and disease progression by 65% compared to placebo in highly active MSers. Therefore without head-2-head comparisons it is difficult to claim one is superior to the other. What differentiates these drugs is induction vs. maintenance and side effects. Alemtuzumab is not licensed yet; the phase 3 results are in and weren't as striking as the phase 2 results (mainly because the study subjects were not as active). The dossiers are in with the FDA and EMA so we should hear soon about a license. Let's hope it is good news. Then the baton will be passed to NICE. It is a long haul, but hopefully we will eventually get there in the end.