Infection risk after alemtuzumab drops with time

Alemtuzumab is the a sledgehammer drug that depresses the immune system such that your T and B cells, monocytes and sometime neutrophils drop, leaving you open to infection. However, the cells rapidly recover  and the infection risk will drop.

The 6 year follow up of the alemtuzumab trials says

Wray S, Havrdova E, Snydman DR, Arnold DL, Cohen JA, Coles AJ, Hartung HP, Selmaj KW, Weiner HL, Daizadeh N, Margolin DH, Chirieac MC, Compston DAS. Infection risk with alemtuzumab decreases over time: pooled analysis of 6-year data from the CAMMS223, CARE-MS I, and CARE-MS II studies and the CAMMS03409 extension study. Mult Scler. 2018 Oct 5:1352458518796675. doi: 10.1177/1352458518796675. [Epub ahead of print]

BACKGROUND: Reduced MS disease activity with alemtuzumab versus subcutaneous interferon beta-1a (SC IFNB-1a) in core phase 2/3 studies was accompanied by increased incidence of infections that were mainly nonserious and responsive to treatment. Alemtuzumab efficacy was durable over 6 years.
OBJECTIVE: To evaluate infections over 6 years in alemtuzumab-treated patients.
METHODS:Three randomized trials (CAMMS223, Comparison of Alemtuzumab and Rebif Efficacy in Multiple Sclerosis (CARE-MS) I, and CARE-MS II) compared two courses of alemtuzumab 12 mg with SC IFNB-1a 44 μg in patients with active relapsing-remitting MS. An extension study (CAMMS03409) provided further evaluation and as-needed alemtuzumab retreatment.
RESULTS: Infections occurred more frequently with alemtuzumab 12 mg than SC IFNB-1a during Years 1 (58.7% vs 41.3%) and 2 (52.6% vs 37.7%), but declined for alemtuzumab-treated patients in Years 3 (46.6%), 4 (42.8%), 5 (40.9%), and 6 (38.1%). Serious infections were uncommon (1.0%-1.9% per year). Infections were predominantly (>95%) mild to moderate and included upper respiratory tract infections, urinary tract infections, and mucocutaneous herpetic infections. Prophylactic acyclovir reduced herpetic infections. Lymphocyte counts after alemtuzumab therapy did not predict infection risk.
CONCLUSION: Infections with alemtuzumab were mostly mild to moderate and decreased over time, consistent with preservation of components of protective immunity.

I guess you can read and with time infection risk drops. Whilst they say these are usually mild, if you are one of the unlucky 1-2%, then it is a problem.

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  • Would you consider Tysabri to be the most 'dangerous' DMT because of the increasing risks associated with prolonged years of use and the devastating consequences of rebound after stopping its use? Or would you say Alemtuzumab is still the DMT with the most potentially serious side effects long term? It will be very interesting to see how effective Cladribine and Ocrelizumab turn out to be compared with these other top DMTs as their side effects seem so much milder from what I've read,especially Cladribine. I recall the following article about problems with Alemtuzumab and neutralizing antibodies: Friday, 16 June 2017
    Attention Alemtuzumab users: When is an Inhibitory Antibody not an Inhibitory Antibody? When its Neutralizing!!
    Rather confusing and complex having to choose from the increasing bunch of therapies but we must be thankful we have this choice as dear folk with diseases such as Motor Neurone Disease have nothing available at all.

    • Natalie unable is a very effective treatment as you say there are risks. We will see more with ocrelizumab and clad as they are used more
      The we home in on what needs to be hit the better will be the risk benefit. However we can do better than using. Sledgehammers

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