Research Article
Volume 12 Issue 4 - 2020
Experience on Use of Alemtuzumab in the Treatment of Relapsing-Remitting Multiple Sclerosis in Mexico: A Real-World Multicenter Study
Irene Treviño-Frenk1,2,3, Luis Enrique Amaya-Sánchez4,5, Velvet Jaqueline Ruiz-Granados6, Verónica Rivas-Alonso5, Luis Enrique Molina-Carrión6, Miguel Ángel Macías-Islas7, Juan Manuel Escamilla-Garza8, Carlos Ferrán Pla-Casamitjana9, Brenda Bertado-Cortés4, Mario Alanís-Quiroga10, Manuel De la Maza-Flores8, Diana Citlalli López-Hernández1,3 and José de Jesús Flores-Rivera2,5*
1Neurology and Psychiatry Department, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City, Mexico
2Neurological Center, ABC Medical Center, Mexico City, Mexico
3School of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
4Centro Médico Nacional “Siglo XXI”, Instituto Mexicano del Seguro Social, Mexico City, Mexico
5Instituto Nacional de Neurología y Neurocirugía “Manuel Velasco Suárez”, Mexico City, Mexico
6Centro Médico Nacional “La Raza”, Instituto Mexicano del Seguro Social, Mexico City, Mexico
7Neuroscience Department, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
8Instituto Tecnológico y de Estudios Superiores de Monterrey, Nuevo León, Mexico
9Medica Sur, Mexico City, Mexico
10Hospital General Universitario de Torreón, Coahuila, Mexico
*Corresponding Author:José de Jesús Flores-Rivera, Subdirección de Neurología, Instituto Nacional Neurología y Neurocirugía “Manuel Velasco Suárez”, Mexico City, Mexico.
Received: February 07, 2020; Published: March 27, 2020




Abstract

Introduction: Multiple sclerosis (MS) is a neuroinflammatory disorder affecting the brain and spinal cord with an autoimmune component. It is the first cause of non-traumatic disability in about 2 million individuals worldwide. Despite several approved disease-modifying therapies (DMT) for the treatment of MS, a high relapsing rate still unresolved. Alemtuzumab is an innovative treatment for relapsing-remitting MS. We aimed to assess the real-world experience of alemtuzumab effectiveness in Mexican medical centers.

Materials and Methods: An observational, retrospective, multicenter, post-marketing study was performed. Data set were collected by a web-based survey. Clinical history, laboratory tests, and imaging scans were collected. The Expanded Disability Status Scale (EDSS) was used to assess disability improvement at 12 and 24 weeks after the treatment onset, before 2nd treatment cycle, and last record. All adverse events experienced along was reported.

Results: A total of 38 cases were recorded, of which 26 (68.4%) were female. The median age was 38.5 years (range 19 - 69). Twentytwo patients (84.2%) were treated with previous DMTs, and 6 (15.8%) started alemtuzumab as the first option. Most participants had an improvement in EDSS after 24 weeks of treatment (24 weeks: 61.3%, before the 2nd cycle: 61.6%, last recorded: 65.8%). The remaining patients had stable EDSS and only one patient had a lower EDSS before their 2nd treatment cycle. An univariate logistic regression analysis showed that, in contrast with relapsing subjects, non-relapsing patients were 3.8 times more likely to have received alemtuzumab (OR 3.81, CI 95% 1.09 - 13.30; p = 0.036).

Conclusion: Alemtuzumab demonstrated its effectiveness and safety for relapsing MS patients in a real-world setting.

Keywords: Multiple Sclerosis; Alemtuzumab; Neurology; Real-World Evidence

References

  1. Compston Alastair and Alasdair Coles. “Multiple Sclerosis”. Lancet 372.9648 (2008): 1502-1517. 
  2. Reich Daniel S., et al. “Multiple Sclerosis”. The New England Journal of Medicine 378.2 (2018): 169-180. 
  3. De la Maza M and G Arrambide. “Prevalencia de Esclerosis Múltiple En El Municipio de San Pedro Garza García, Nuevo León”. Medicina Interna de México 3.9 (2006): 7-10.
  4. Dubey Divyanshu., et al. “Intractable and Highly Active Relapsing Multiple Sclerosis - Role of Alemtuzumab”. Neuropsychiatric Disease and Treatment 11 (2015): 2405-2414. 
  5. Freedman Mark S and Carolina A. Rush. “Severe, Highly Active, or Aggressive Multiple Sclerosis”. Continuum 22.3 (2016): 761-784. 
  6. Bergamaschi Roberto. “Prognostic Factors in Multiple Sclerosis”. International Review of Neurobiology 79 (2007): 423-447. 
  7. Guillemin Francis., et al. “Older Age at Multiple Sclerosis Onset Is an Independent Factor of Poor Prognosis: A Population-Based Cohort Study”. Neuroepidemiology 48.3-4 (2017): 179-187. 
  8. Cerqueira João J., et al. “Time Matters in Multiple Sclerosis: Can Early Treatment and Long-Term Follow-up Ensure Everyone Benefits from the Latest Advances in Multiple Sclerosis?” Journal of Neurology, Neurosurgery, and Psychiatry 89.8 (2018): 844-850. 
  9. Curkendall Suellen M., et al. “Potential Health Care Cost Savings Associated with Early Treatment of Multiple Sclerosis Using Disease-Modifying Therapy”. Clinical Therapeutics 33.7 (2011): 914-925. 
  10. Skromne-Eisenberg Eli., et al. “Disease-Modifying Therapies in Multiple Sclerosis in Latin America”. Multiple Sclerosis Journal - Experimental, Translational and Clinical 3.3 (2017): 2055217317723369. 
  11. Berger T. “Immunological Processes Related to Cognitive Impairment in MS”. Acta Neurologica Scandinavica 134.200 (2016): 34-38. 
  12. Ziemssen Tjalf and Katja Thomas. “Alemtuzumab in the Long-Term Treatment of Relapsing-Remitting Multiple Sclerosis: An Update on the Clinical Trial Evidence and Data from the Real World”. Therapeutic Advances in Neurological Disorders 10.10 (2017): 343-359. 
  13. Cohen Jeffrey A., et al. “Alemtuzumab versus Interferon Beta 1a as First-Line Treatment for Patients with Relapsing-Remitting Multiple Sclerosis: A Randomised Controlled Phase 3 Trial”. Lancet 380.9856 (2012): 1819-1828. 
  14. Coles Alasdair J., et al. “Alemtuzumab CARE-MS II 5-Year Follow-up: Efficacy and Safety Findings”. Neurology 89.11 (2017): 1117-1126.
  15. Havrdova Eva., et al. “Alemtuzumab CARE-MS I 5-Year Follow-up: Durable Efficacy in the Absence of Continuous MS Therapy”. Neurology 89.11 (2017): 1107-1116. 
  16. Ziemssen T., et al. “[Real-world evidence: Benefits and limitations in multiple sclerosis research]”. Der Nervenarzt 88.10 (2017): 1153-1158. 
  17. Prosperini Luca., et al. “No Evidence of Disease Activity (NEDA-3) and Disability Improvement after Alemtuzumab Treatment for Multiple Sclerosis: A 36-Month Real-World Study”. Journal of Neurology 265.12 (2018): 2851-2860. 
  18. Jongen Peter Joseph. “Health-Related Quality of Life in Patients with Multiple Sclerosis: Impact of Disease-Modifying Drugs”. CNS Drugs 31.7 (2017): 585-602. 
  19. Gracia Fernando., et al. “Esclerosis Múltiple En América Central y El Caribe: Estado Actual y Recomendaciones Clínicas”. Revista Mexicana de Neurociencia 18.2 (2017): 76-88.
  20. Kabata Tamon., et al. “Vascular Endothelial Growth Factor in Rabbits during Development of Corticosteroid-Induced Osteonecrosis: A Controlled Experiment”. The Journal of Rheumatology 35.12 (2008): 2383-2390. 
  21. Meza Rafael., et al. “Burden of Type 2 Diabetes in Mexico: Past, Current and Future Prevalence and Incidence Rates”. Preventive Medicine 81 (2015): 445-450. 
  22. Rtveladze Ketevan., et al. “Obesity Prevalence in Mexico: Impact on Health and Economic Burden”. Public Health Nutrition 17.1 (2014): 233-239. 
  23. Marrie Ruth Ann., et al. “Effect of Comorbidity on Mortality in Multiple Sclerosis”. Neurology 85.3 (2015): 240-247. 
Citation: Irene Treviño-Frenk., et al. “Experience on Use of Alemtuzumab in the Treatment of Relapsing-Remitting Multiple Sclerosis in Mexico: A Real-World Multicenter Study”. EC Neurology 12.4 (2020): 69-79.

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