The CARE-MS II two year study compared Lemtrada (alemtuzumab) (426 participants) and Rebif (interferon beta 1a) (202 participants) in people who had taken a disease modifying drug but continued to have relapses. As well as recording relapses and lesions seen on MRI scans, several different measures were used to monitor disability at the start of the study and then every three months.

In a new analysis of the data which looked more closely at the disability measures, researchers have shown that over the course of the study, 28% of those taking Lemtrada showed at least a one point improvement in disability measures (EDSS) compared with 15% of those taking Rebif.

Compared to Rebif, people taking Lemtrada were more than 2.5 times as likely to have improved thinking skills (cognition) and more than twice as likely to have improved coordination of movements (ataxia). Improvements were also seen in hand and arm function.

The researchers considered the possible explanations for these results and excluded the possibility that improvements were due to people recovering from an earlier relapse. They speculate that reduction in MS activity in the brain and spinal cord might enhance remyelination and other repair processes, but acknowledge that considerably more work is needed to investigate possible mechanisms for the improvements seen.

The MS Trust welcomes this very interesting study. It is encouraging to see evidence that a disease modifying drug can show improvement in levels of disability, rather than just slowing or preventing further progression. We also welcome the move to a more holistic understanding of disability taken by this study, including upper limb function and thinking skills, and not just mobility, as meaningful measures.

This is a two year study; data from longer studies will help us understand if improvements in disability and symptoms are maintained over longer time periods.

Amy Bowen, Director of Service Development

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Lemtrada (alemtuzumab) is a highly effective disease modifying drug for people with relapsing remitting MS.  You take Lemtrada as an intravenous infusion (drip) in two treatment courses, twelve months apart. It reduces the number of relapses by about two thirds (70%), compared to taking placebo. Common side effects include infusion-related reactions which are generally mild and short-lived and increased risk of infections following a treatment course. Additional serious side effects include thyroid disorders, kidney problems and blood clotting problems.  These side effects are treatable if caught early enough by regular montly blood and urine tests.

There are 11 disease modifying drugs approved for use by the NHS, each with its own balance of benefits and risks. The MS Trust's interactive decision aid, MS Decisions helps people find out more about the drugs, discuss their options with their MS team and make an informed choice about their treatment, and was recently highly commended by the British Medical Association.

References

  • Giovannoni G, et al. Alemtuzumab improves pre-existing disability in active relapsing-remitting MS patients Neurology 2016 Oct 12. [Epub ahead of print] Full article

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