Tagalemtuzumab

Thyroid disease with Alemtuzumab – risk mitigation

There is a popular old saying in English – “forewarned is forearmed”. Prior knowledge that something is going to happen offers tactical advantage, whether you’re at war or simply everyday life. The difficulty, however, is that more often than not we are transfixed by the detail of the matter, resulting in numerous avenues of investigation in the process, some of which are...

AAN 2019 posters #2

Well, here is part deux of the 2019 AAN posters; a veritable smorgasbord of hidden gems on Market St in Philadelphia. 1. Effect of Ibudilast on Neurofilament light chain in Progressive MS Analysis from a Phase II Trial. Fox et al. Cleveland Clinic.Previous results from the SPRINT-MS study that used 80-100mg/day of Ibudilast, showed slowing of the progression in brain atrophy (i.e. volume loss) by...

Jetlag

Just arrived back from the AAN 2019 in Philadelphia. Jetlagged, which is why I am writing this at 2 am in the morning. As always the AAN is more a meeting of meetings or networking in academic lingo. These meetings have allowed us to progress several of our ideas including (1) DrK’s #MSAttack study with natalizumab, (2) to think more deeply about our proposed ADIOS Trial (adaptive dosing...

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...

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