Alemtuzumab

How it works

It binds CD52 on lymphocytes, causing depletion of circulating T and B cells followed by a distinctive pattern of immune reconstitution that reduces inflammatory relapse activity.

Prescribing in practice

• It carries serious risks of secondary autoimmune disease (notably thyroid disorders, immune thrombocytopenia and anti-GBM nephropathy), serious infusion reactions, stroke and arterial dissection, so it is restricted to specialist use under a risk-management programme with prolonged monthly monitoring.
• Premedication, anti-herpes prophylaxis and infection screening are required around each treatment course.
• Monthly blood and urine monitoring must continue for several years after the last dose.

Monitoring

Monitor full blood count, renal function, urinalysis and thyroid function monthly for an extended period after each course.

Counselling the patient

• Attend every monthly blood and urine test, even when you feel well, for several years after treatment.
• Report bruising, bleeding, swelling, palpitations or symptoms suggesting infection promptly.
• Seek urgent help for sudden severe headache, neck pain or weakness after an infusion.

Evidence & guidelines

Use is governed by MHRA safety restrictions and a controlled risk-minimisation programme following reports of serious cardiovascular and immune-mediated reactions.