About 5 or more years ago Prof G and I went to see Genzyme to propose a study on doing B cell depletion after alemtuzumab to try and limit, ideally prevent, secondary autooimmunity that occurred in about 50% of people with MS who were treated with MS.
At the time there was no ocrelizumab, cladribine in the picture and they simply were not interested in B cells. They thought T regs increased after alemtuzumab and they were not interested in doing the study.
We would have had an answer by now and maybe just maybe, this would still be the go-to treatment rather than having it at the bottom of the pile, certainily if the EMA continue with their current view.
(Update). Now this idea was a trial to prevent secondary autoimmunity by zapping the B cells as they emerge after alemtuzumab. But if you dont do this you have to treat the fall out of the alemtzumab treatment
In OZ they don’t say wait until pharma fund it, they just get on and do it. This work is by the Brother of the Ex-Blackburn Footballer of the same surname, for those interested in football. Irrelevant for those not interested.
B cell depletion therapy resulting in sustained remission of severe autoimmune complications following Alemtuzumab treatment of Multiple Sclerosis. Massey J, Barnett Y, Curnow J, Sutton I. Mult Scler Relat Disord. 2019 Jul 20;35:100-103
Secondary autoimmune disorders (AID) are a recognised complication of alemtuzumab treatment for multiple sclerosis. We have previously reported two female multiple sclerosis patients treated with alemtuzumab who developed rare but severe secondary AID; acquired haemophilia A and autoimmune encephalitis with seizures. Both cases proved to be refractory to treatment with conventional immuno-therapy. However, treatment of the patients with anti-CD20 therapy resulted in sustained remission. This observation validates anti-CD20 therapy as a potential treatment option in patients with autoimmune complications of alemtuzumab that are postulated to arise as a result of B cell hyperpopulation.
This is treatig the autoimmunity not preventing it
However, you need foresight, because now, it is rather late to try answer the question we posed all those years ago, most people will say give me ocrelizumab, cladribine etc, etc and so you will find it hard to recruit to such a study.
Will Roche take the plunge and see if they need to dose as frequently as every six months to try limit infection risk?
Do we say what risk? You are too theoretical, after all it is indeed well tolerated by most people.
Snooze and you lose for what is otherwise a useful treatment.
Are they sleeping? You heard about OXO this week…We need to do ADIOS