HSCT vs. Alemtuzumab

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So this is not a head to head efficacy study but says what we know alemtuzumab is associated with thyroid disease, HSCT is associated with more infections

Safety of Alemtuzumab and Autologous Hematopoietic Stem Cell Transplantation Compared to Non-induction Therapies for Multiple SclerosisPeter Alping, Joachim Burman, Jan Lycke, Thomas Frisell, Fredrik PiehlNeurology Jan 2021, 10.1212/WNL.0000000000011545; 

Objective: To assess safety outcomes for the induction therapies alemtuzumab and autologous hematopoietic stem cell transplantation (AHSCT), compared to non-induction disease-modifying therapies.

Methods: We performed a population-based cohort study linking the Swedish Multiple Sclerosis Register to national healthcare registers. Alemtuzumab, AHSCT, and a matched reference group of non-induction therapies (natalizumab, dimethyl fumarate, rituximab, fingolimod) were included if started between 2008 and 2017. Main outcomes were death, thyroid disease, non-thyroid autoimmune disease, and infection.

Results: We identified 132 alemtuzumab-treated and 139 AHSCT-treated (68% Cy/ATG, 32% BEAM/ATG) patients, together with 2486 matched patients treated with non-induction therapies. Four patients in the alemtuzumab group died (incidence rate [IR] per 1000 person years=8.6, 95% confidence interval [CI]=2.3–22.0) compared to one patient in the AHSCT group (IR=1.7, 95% CI=0.0–9.6) and a mortality rate in the reference group of 0.7 (95% CI=0.3–1.3). Thyroid disease was most frequent in the alemtuzumab group (IR=109, 95% CI=75–154), but also occurred more often for AHSCT (IR=34, 95% CI=18–56) compared to the reference (IR=5.3 95% CI=3.9–7.1). The incidence of non-thyroid autoimmune disease was similar in all groups. IR for infection diagnosed ≥6 months from therapy initiation was 53 (95% CI=30–87) for alemtuzumab, 108 (95% CI=75–150) for AHSCT, and 51 (95% CI=46–57) for the reference.

Conclusion: We confirmed a high incidence of thyroid disease in alemtuzumab- and to a smaller extent also AHSCT-treated patients, and found a higher incidence of infection for AHSCT, compared to both alemtuzumab and non-induction therapies. The incidence of non-thyroid autoimmune disease was low for both therapies.

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4 comments

  • HSCT and Alemtuzumab are effective against highly active MS

    Is there any evidence that they could be even more effective against milder MS. Or has it only been tested on severe cases?

    As a first line and possible cure to MS, are the potential side effects worth the risk vs reward?

  • Four deaths but were there any co-morbidities? Were the deaths directly attributed to alemtuzamab? Were all follow up blood tests performed and checked? If it turns out the deaths were directly linked to the treatment and all other check were performed then yes I’d find that alarming too!

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