Several clinical trials have shown that alemtuzumab (Lemtrada) effectively reduces relapse rates in patients with multiple sclerosis (MS), and improves disability in the early stages of the disease. A new study adds to evidence of the drug’s efficiency by finding that it affects different aspects of disability to varying degrees, a finding that deepens the understanding of how the treatment modifies MS.
MS disease progression is typically measured using the Expanded Disability Status Score (EDSS), which is composed of items measuring the contribution of symptoms from seven functional systems. Deficits in these systems — the bowel/bladder, brain stem, cerebellum, cerebrum, pyramidal, sensory, and visual functioning — mirror different aspects of disability. In early MS, impairments in these functions contribute more to overall disability than the loss of the capacity to walk.
The Phase 2 clinical trial compared alemtuzumab to interferon-beta 1a therapy on outcomes in these functional systems.
Lead by Central Texas Neurology Consultants, the study showed that alemtuzumab was superior to interferon-beta 1a in improving the function of most systems when measured after 36 months. Researchers noted the largest effect of alemtuzumab on sensory, pyramidal, and cerebellar functional systems, which govern muscle movement and fine-tuning, as well as the processing of sensory information. Interferon-beta 1a was only beneficial for improving pyramidal symptoms.
Next, patients were split into two groups, depending on whether they showed increased or decreased disability accumulation after six months. The research team noted that in patients who became worse, decline was mostly seen in the brain stem and sensory functions. The brain stem governs basic functions such as breathing and heart rate, but is also an important relay station and a source of many facial nerves. In contrast, patients who improved during the same period had the largest improvement in the pyramidal and sensory systems.
The study again confirmed alemtuzumab’s benefits compared to interferon treatment, and showed that the drug most strongly affected the systems driving disease progression in the early phases of relapsing-remitting MS.