Alemtuzumab

How it works

It binds CD52 on lymphocytes causing antibody-dependent cell lysis and profound depletion, followed by immune reconstitution that is thought to reduce inflammatory disease activity.

Prescribing in practice

• It carries serious risks including secondary autoimmune disorders (notably thyroid disease, immune thrombocytopenia and anti-GBM nephropathy), serious infusion reactions, stroke and cardiovascular events, so MHRA-mandated restrictions, premedication and a long-term monthly monitoring programme apply.
• Use is restricted to specified relapsing multiple sclerosis populations under specialist neurology supervision with a controlled-access and monitoring scheme.
• Antiviral and other infection prophylaxis is required around treatment courses, with screening for latent infections beforehand.

Monitoring

Perform monthly blood and urine monitoring (including full blood count, renal function and urinalysis) and periodic thyroid function tests for several years after the last course.

Counselling the patient

• Continue the monthly blood and urine tests for years after treatment even when you feel well.
• Report symptoms such as easy bruising or bleeding, neck swelling, dark urine or signs of infection promptly.
• Seek urgent care for chest pain, severe headache or sudden weakness shortly after an infusion.

Evidence & guidelines

Use is informed by the CARE-MS trials and is subject to MHRA risk-minimisation measures restricting its indication.