Longitudinal assessment of neurocognitive function in people with relapsing multiple sclerosis initiating alemtuzumab in routine clinical practice: LEM-COG study results.

Background: Alemtuzumab is effective in reducing relapse rate and disability, but limited data exist on its effect on cognitive function in relapsing multiple sclerosis (RMS). The present study assessed neurocognitive function and safety associated with alemtuzumab treatment in RMS.
Methods: This longitudinal, single-arm, prospective study included people with RMS (aged 25-55 years) who were treated with alemtuzumab in clinical practice in the United States of America and Canada. The first participant was enrolled in December 2016. The primary endpoint was the change from baseline to post-baseline (month [M] 12/24) in MS-COGnitive (MS-COG) composite score. Secondary endpoints included Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), Brief Visuospatial Memory Test-Revised (BVMT-R), Selective Reminding Test (SRT), Controlled Oral Word Association Test (COWAT), and Automated Neuropsychological Assessment Metrics (ANAM) scores. Depression and fatigue were assessed using Hamilton Rating Scale-Depression (HAM-D) and Fatigue Severity Scale (FSS)/Modified Fatigue Impact Scale (MFIS), respectively. Magnetic resonance imaging (MRI) parameters were assessed when available. Safety was assessed throughout the study. Descriptive statistics were used for the pre-specified statistical analyses. Since the study was terminated early (November 2019) because of operational and resource difficulties, post hoc analyses for statistical inference were performed among participants who had a baseline value and at least one complete post-baseline assessment for cognitive parameters, fatigue, or depression.
Results: Of the 112 participants enrolled, 39 were considered as the primary analysis population at M12. At M12, a mean change of 0.25 (95% confidence interval [CI]: 0.04, 0.45; p = 0.0049; effect size [ES]: 0.39) was observed in the MS-COG composite score. Improvements were observed in processing speed (based on PASAT and SDMT; p < 0.0001; ES: 0.62), as well as in individual PASAT, SDMT and COWAT scores. An improvement was also noted in HAM-D (p = 0.0054; ES: -0.44), but not in fatigue scores. Among MRI parameters, decreases in burden of disease volume (BDV; ES: -0.12), new gadolinium-enhancing lesions (ES: -0.41) and newly active lesions (ES: -0.07) were observed at M12. About 92% of participants showed stable or improved cognitive status at M12. There were no new safety signals reported in the study. The most common adverse events (≥10% of participants) were headache, fatigue, nausea, insomnia, urinary tract infection, pain in extremity, chest discomfort, anxiety, dizziness, arthralgia, flushing, and rash. Hypothyroidism (3.7%) was the most frequent adverse event of special interest.
Conclusion: The findings from this study suggest that alemtuzumab has a positive impact on cognitive function with significant improvements in processing speed and depression in people with RMS over a period of 12 months. The safety profile of alemtuzumab was consistent with previous studies.
Competing Interests: Declaration of Competing Interest This study was funded by Sanofi. Jeffrey Wilken received grants from Biogen; grants and personal fees from Sanofi; consulting fees from Bristol Myers Squibb (BMS); and speaker fees from Biogen, Sanofi, and Serono. Anthony Traboulsee is the MS Society of Canada Research Chair at the University of British Columbia (UBC) supported by the MS/MRI Research Group and received research funding from the MS Society of Canada, Roche, and Sanofi; and also received honoraria or travel support from Consortium of MS Centers, Roche, Sanofi. Flavia Nelson is funded by National Institutes of Health (NIH), the University of Minnesota Institute for translational Neuroscience and is an advisor for Sanofi, Genentech, BMS, Horizon and Novartis. Carolina Ionete reported receiving compensation for advisory board participation for Sanofi, and research support from NIH, National Multiple Sclerosis Society (NMSS), Department of Defense (DOD), Consortium of MS Centers, Dan and Diane Riccio Foundation, Biogen, Roche, and Novartis. Shannon Kolind received research support from Roche, Genzyme, the MS Society of Canada, the Natural Sciences and Engineering Research Council (NSERC), Vancouver Coastal Health Research Institute (VCHRI), Michael Smith Foundation for Health Research (MSFHR), the Canadian Institutes of Health Research (CIHR), Brain Canada, and Milan & Maureen Ilich Foundation, and consulting fees from Novartis. Timothy Fratto has nothing to disclose. Robert Kane has been a consultant for Biogen Idec. Roopali Gandhi, Andreea M. Rawlings, and Nora Roesch are employees of Sanofi and may hold stock and/or stock options in the company. Mark A. Ozog was an employee of Sanofi and may hold stock and/or stock options in the company (at the time of study). John DeLuca reported personal compensation for consulting from Celgene/BMS, Biogen Idec, Novartis, Consortium of MS Centers, and MedRhythms; is a speaker for Sanofi, Biogen IDEC and Excemed; received grant funding from Biogen Idec, EMD Serono, Canadian MS Society, NIH, National Multiple Sclerosis Society, and Consortium of MS Centers.
(Copyright © 2023. Published by Elsevier B.V.)