Switching from fingolimod to alemtuzumab in patients with highly active relapsing-remitting multiple sclerosis: Α case series.

Background: The management of "aggressive" and "highly-active" relapsing-remitting multiple sclerosis remains problematic. Although a number of highly efficacious agents are currently available, the optimal timing of their use and the balancing between efficacy and immediate and long-term consequences are still a matter of conjecture.
Methods: We describe the clinical, radiological and immunological profile of three multiple sclerosis patients with persistent clinical and radiological disease activity under fingolimod treatment. After fingolimod cessation patients demonstrated severe disease exacerbation and were successfully treated with alemtuzumab.
Results: All patients experienced significant improvement after the administration of alemtuzumab and achieved no evidence of disease activity status that persisted after a median of 19 months of follow-up (range: 17-25 months). Confirmed disability improvement was achieved in all cases. Quantitative MRI data demonstrated a reduction of the T2 lesion load in 2 out of 3 patients and complete abrogation of inflammatory activity in all patients after the administration of alemtuzumab. Α patient presented a previously unreported, persistent lymphocytosis after alemtuzumab administration, that was not associated with infectious, lymphoproliferative or autoimmune diseases and had no apparent clinical implications.
Conclusions: Alemtuzumab appears to be an effective and safe short-term therapeutic option both as a rescue therapy for the disease flare-up associated with fingolimod withdrawal, as well as for the reversal of the deteriorating course observed in patients who fail treatment with fingolimod.
Competing Interests: Declaration of Competing Interest K.N received travel grants and/or speaking honoraria and consultation fees from Sanofi Genzyme, Novartis, Genesis Pharma, Teva, Mylan N.V., Roche and Merck; received research grants from Genesis Pharma. E.P declared no relative to this work conflict of interest. A.O. received travel grants and/or speaking honoraria and consultation fees from Merck, Bayer Schering, Sanofi Genzyme, Teva, Novartis, Genesis Pharma, Mylan N.V., Roche; received research grant support from Merck, Sanofi Genzyme, Teva, Novartis, Genesis Pharma. M.M. received travel grants from Sanofi Genzyme, Novartis, Mylan N.V. and Merck and research grants from Sanofi Genzyme. V.K.K. within the past 24 months received honoraria as a member of an advisory board or panel from Teva, Sanofi Genzyme, UCB, Genesis Pharma and Merck.
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