Abstract
This article will review current treatment options for multiple sclerosis (MS) while keeping our primary focus on alemtuzumab, as it is now approved in more than 65 countries. From a pathophysiological point of view, MS is a disabling disease impacting a patient's life both physically and mentally, leading to devastating social and economic impact. This review will elaborate on alemtuzumab's role in treating relapsing-remitting MS (RRMS) by comparing its efficacy, side effects, and monitoring with other disease-modifying therapies (DMTs) available in the market. It is a point of great concern not only for physicians but also for neurologists, nephrologists, endocrinologists, dermatologists, and oncologists when encountering long-term effects of alemtuzumab in the life of treated MS patients. We hope that our review will not only benefit treating faculties but also those who are suffering from this devastating disease.
Highlights
BackgroundMultiple sclerosis (MS) is a chronic, inflammatory, neurodegenerative autoimmune disease caused by proliferation and activation of autoreactive lymphocytes that react against unidentified autoantigens and start inflammation in coordination with proinflammatory cytokines [1]
Another study showed that B cells carry programed death ligand (CD19+PD-L1hi cells) that produces its regulatory effects through cell-to-cell contact through the interaction of (CD19+PD-L1hi cells) with PD-1 on T cells, which results in the termination of T follicular helper (Tfh) cell differentiation and proliferation, leading to the relapse of symptoms of multiple sclerosis (MS) patients [3,4]
The current study showed that adverse reactions were mild when patients were treated with natalizumab than alemtuzumab, as there were less intense immune-mediated thrombocytopenia (ITP), Graves' disease, nausea, and respiratory tract infection symptoms [27]
Summary
Multiple sclerosis (MS) is a chronic, inflammatory, neurodegenerative autoimmune disease caused by proliferation and activation of autoreactive lymphocytes that react against unidentified autoantigens and start inflammation in coordination with proinflammatory cytokines [1]. In a comparison of alemtuzumab with Rebiff (CARE-MS I) and (CARE-MS II), clinical trial patients with active disease who were enrolled in the study were taking subcutaneous interferon-b (SC IFN-b) for two years and had an inadequate response to this drug. The efficacy and sustainability of this medication were compared to alemtuzumab After switching to this drug, our data showed that after five years of follow-up, cerebral atrophy and disease activity were reduced, and there were improvements in expanded disability status score (EDSS) and annualized relapse rate (ARR). CARE-MS: comparison of alemtuzumab with Rebiff efficacy in multiple sclerosis, NEDA: no evidence of disease activity, EDSS: expanded disability status score, CDI: confirmed disability improvement, SIP-1: sphingosine 1 phosphate receptors, IFN-B: interferon-beta, EF-2: elongation factor-2, IL-17: interleukin-17, IFN-gamma: interferon-gamma, TNF-a: tumor necrosis factor-a, TH-1: T-helper 1. Alemtuzumab is the most cost-effective drug treatment for RRMS compared with other DMTs because it provided durable efficacy in the absence of the continuous need to administer it for patients
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