Accelerated lymphocyte recovery after alemtuzumab does not predict multiple sclerosis activity
Onajite Kousin-Ezewu1, Laura Azzopardi1, Richard A Parker1
1From the Department of Clinical Neurosciences (O.K.-E., L.A., O.T., A. Compston, A. Coles, J.J.) and the Centre for Applied Medical Statistics, Department of Public Health and Primary Care (R.A.P.), University of Cambridge, UK.
Neurology
|May 20, 2014
Summary
Peripheral blood mononuclear cell recovery after alemtuzumab treatment for multiple sclerosis (MS) did not predict disease activity. CD4 counts at 12 months were not useful for guiding further MS treatment decisions.
Area of Science:
- Immunology
- Neuroscience
- Clinical Trials
Background:
- Alemtuzumab is a treatment for multiple sclerosis (MS) that affects immune cell recovery.
- Understanding immune cell dynamics post-treatment is crucial for managing MS.
- Previous hypotheses suggested a link between accelerated cell recovery and disease recurrence.
Purpose of the Study:
- To evaluate if faster peripheral blood mononuclear cell (PBMC) recovery after alemtuzumab correlates with recurrent MS activity.
- To determine if CD4 counts at 12 months can predict patient response to further treatment.
Main Methods:
- 108 MS patients treated with alemtuzumab were monitored for a median of 99 months.
- Disease activity was assessed through clinical relapses, disability progression, and MRI lesions.
- PBMC subsets (CD4, CD8, CD19, NK cells, monocytes) were quantified and correlated with disease outcomes.
Main Results:
- Alemtuzumab significantly reduced annualized relapse rates by 90% compared to pre-treatment levels.
- No significant difference in the recovery rates of CD19, CD8, or CD4 cells was observed between patients with active versus non-active MS.
- Cell counts did not correlate with disease activity or sustained accumulation of disability post-alemtuzumab treatment.
Conclusions:
- Peripheral blood cell counts are not reliable biomarkers for predicting active MS disease after alemtuzumab therapy.
- The hypothesis linking accelerated PBMC recovery to recurrent disease activity is not supported by this study.
- CD4 counts at 12 months are not effective in identifying MS patients who may benefit from additional treatment.
