Her medical team found diffuse alveolar hemorrhage in this patient — which resolved in about a week without treatment. The scientists advised that clinicians be alert to signs of lung bleeding in MS patients using Lemtrada, such as a sudden onset of respiratory distress or coughing up blood.
This case study is the first to be published, the team said, but four other reports of such hemorrhage in MS patients are registered with the World Health Organization database, known as VigiBase. All five MS patients recovered, but 14 fatalities are noted among 17 people with other diseases given alemtuzumab “as part of immunosuppression for transplantation or for haematological malignancies,” the scientists report.
The study, “Diffuse alveolar hemorrhage during alemtuzumab infusion in a patient with multiple sclerosis: a case report,” was published in the journal BMC Pharmacology and Toxicology.
After five years of being treated with interferon beta1-b (sold as Extavia, Betaseron) following her RRMS diagnosis, the 29-year old woman switched treatment to Lemtrada, owing to evidence of new brain lesions on MRI scans and an MS flare. There was a four-month wait before changing therapies.
Lemtrada, marketed by Sanofi Genzyme, is a monoclonal antibody working to reduce relapses and delay disease progression in people with RRMS. The medicine is given as eight total intravenous infusions over two years, an initial dosing cycle for five consecutive days that’s followed by a second three-day cycle one year later.
The patient started her first cycle of Lemtrada (at 12 mg each day), but at the end of her second infusion began experiencing chest pain while inhaling. She also experienced shortness of breath and cough, and four hours later started to cough up blood.
A chest X-ray and a computed tomography (CT) scan revealed a shadowing in the lungs, consistent with diffuse alveolar bleeding. There was no evidence of disease-causing bacteria, viruses, or atypical cells.
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