This is a paper that may be of interest to people who have taken alemtuzumab in the past few years.
It looks at the conversion rate to SPMS.
Sadly I think an error has been made from relegating alemtuzmab from being the the easiest drug to prescribe first line to being a drug that has been thrown on the maggot-pile by the regulators to be essentially third line. The risk is yours not theirs.
Proportion of alemtuzumab-treated patients converting from relapsing-remitting multiple sclerosis to secondary progressive multiple sclerosis over 6 years.Horáková D, Boster A, Bertolotto A, Freedman MS, Firmino I, Cavalier SJ, Jacobs AK, Thangavelu K, Daizadeh N, Poole EM, Baker DP, Margolin DH, Ziemssen T; CARE-MS I, CARE-MS II, and CAMMS03409 Investigators.Mult Scler J Exp Transl Clin. 2020 Dec 18;6(4):2055217320972137
Background: Few data exist concerning conversion to secondary progressive MS in patients treated with disease-modifying therapies.
Objective: Determine the proportion of alemtuzumab-treated patients converting from relapsing-remitting to secondary progressive MS during the CARE-MS core and extension studies.
Methods: Patients (N = 811) were analyzed post hoc for secondary progressive MS conversion. Optimal conversion definition: Expanded Disability Status Scale (EDSS) score ≥4, pyramidal functional system score ≥2, and confirmed progression over ≥3 months including confirmation within the functional system leading to progression, independent of relapse.
Results: Over 6.2 years median follow-up, 20 alemtuzumab-treated patients converted (Kaplan-Meier estimate, 2.7%; 95% confidence interval, 1.8%-4.2%). Sensitivity analysis accounting for dropouts showed similar results (3%), as did analyses using alternative definitions with different EDSS thresholds and/or confirmation periods, and analysis of core study subcutaneous interferon beta-1a-treated patients who received alemtuzumab in the extension. Patients converting to secondary progressive MS were older, and had higher EDSS scores and greater brain lesion volumes at baseline, but did not need additional alemtuzumab or other therapies.
Conclusions: The 6-year conversion rate to secondary progressive MS was low for alemtuzumab-treated patients, supporting further study of the role alemtuzumab may play in reducing risk of secondary progression.ClinicalTrials.gov identifiers: NCT00530348, NCT00548405, NCT00930553
This suggests that the regulators are going to limit the benefit that has to offer by using it late.
However there is an experiment to be done to see how quick you need to get onto high efficacy DMT.
The trials were beta interferon or alemtuzumab and then after 2 years everyone goes on alemtuzumab
MS CARE I = treatment naive treatment within 2 years of onset (a) Alemtuzumab = 1 year (b) Beta interferon for 2 years then alemtuzumab for 1 year
CARE_MS II trial = treatment in within 4 years in people taking beta interferon.a) Beta intereferon for 2 years then Alemtuzumab = 1 year (b) Beta interferon for 2 years then beta interferon for 2 years then alemtuzumab for 1 year
so you have alemtumab, beta interferon 2 year then alemtuzumab and beta interferon 4 years and then alemtuzumab then ask when secondary progression occurred.