Tagalemtuzumab

Yellow Fever Vaccine Alert

In the past, I have made the claim that vaccinations, including vaccination with live attenuated viruses such as yellow fever, are relatively safe post-IRTs (immune reconstitution therapies) such as alemtuzumab, cladribine and HSCT. I even have two Alemtuzumabers on my books who have both had yellow fever vaccines before travelling to Ecuador and the Galapagos Islands. who I frequently mention in...

Hepatitis post-alemtuzumab

Another alemtuzumab-related post, this time in relation to alemtuzumab-associated liver injury, which has been also been included as a complication of alemtuzumab treatment in the EMA’s SmPC (summary of product characteristics). Liver or hepatic injury can occur as part of a drug-induced injury as seen in case 2 below or as a delayed, presumably autoimmune, condition as in case 1 below...

Haemophagocytic lymphohistiocytosis post-alemtuzumab

After yesterday’s post on alemtuzumab-related posts, many people are asking about haemophagocytic lymphohistiocytosis (HLH), which has been included as a complication of alemtuzumab treatment as is now in the SmPC (summary of product characteristics). HLH is a condition in which the body makes too many activated macrophages and lymphocytes. People with HLH usually develop systemic symptoms, which...

Alemtuzumab’s Article 20

Use of multiple sclerosis medicine Lemtrada restricted while EMA review is ongoing EMA has started a review of the multiple sclerosis medicine Lemtrada (alemtuzumab) following new reports of immune-mediated conditions (caused by the body’s defence system not working properly) and problems with the heart and blood vessels with the medicine, including fatal cases. As a temporary measure while the...

Does alemtuzumab treatment increase your chances of having a miscarriage or premature birth? A large systematic review of numerous studies involving women with ‘normal thyroid function’ showed a strong association between the presence of anti-thyroid peroxidase antibodies and having a miscarriage and/or premature birth, i.e. the chances were increased by approximately 3.9x and 2.1x, respectively...

Listeriosis

Can we prevent alemtuzumab-associated listeriosis? The following is a published case report of someone with MS developing listeriosis congruent with their second course of alemtuzumab treatment. It is clear this patient was not taking her diatary advice very seriously. We have a potential solution for this problem. Holmøy et al. Listeria monocytogenes infection associated with alemtuzumab – a...

Alemtuzumab rescue therapy for rebound after stopping natalizumab

Natalizumab is an effective strategy for achieving disease control in those with highly-active MS, but owing to the risk of progressive multifocal leucoencephalopathy (PML), often needs to be de-escalated. However, discontinuation of natalizumab therapy is not without its own risks; the biggest risk being rebound activity, which rarely may be a flare beyond that of pre-treatment disease activity...

News for alemtuzumabers

Prof G what can be done to manage my hyperthyroidism if I want to fall pregnant? Carbimazole is associated with an increased risk of congenital malformations, especially when administered in the first trimester of pregnancy and at high doses. Women of childbearing potential should use effective contraception during treatment with carbimazole. Carbimazole: increased risk of congenital...

NEDADI or ‘Nee Daddy’ another treatment target beyond NEDA

Prof G do you think disability improvement is a reasonable treatment goal? NEDADI = no evident disease activity and disability improvement Two weeks ago one of my patients with PPMS, who we treated with off-label subcutaneous cladribine, came for her annual follow-up appointment. Despite being treated with cladribine over 2 years ago she has unfortunately progressed from EDSS 5.5 to 6.5. Her...

Beyond NEDA

Prof G are we being lulled into a false sense of security by being told that we have no evident disease activity (NEDA)? A patient of mine, who I have been looking after now for over 11 years, asked me in clinic a few weeks ago why despite being NEDA for 6 years, on a highly effective maintenance DMT (fingolimod), has she gone from being able to run 5-10 km to needing a stick and barely managing...

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