Contributions
Abstract: EP1716
Type: Poster Sessions
Abstract Category: Therapy - Others
Background: Alemtuzumab(ALEM) is a highly effective monoclonal anti-CD52 antibody approved for patients with active multiple sclerosis(MS). The most common ALEM's adverse events(AE) are infusion reactions(IRs). Three out of 100 IRs are severe and contraindicate treatment prosecution with the traditional schedule.
Methods: a case report
Results: a 45-year-old female, diagnosed with MS in 1998, was treated with several therapies, but only had a complete response to natalizumab. However, natalizumab had been discontinued for a high progressive multifocal leucoencephalopathy risk. After last treatment failure with fingolimod, she was started on ALEM without any AE and with an optimal clinical and neuroradiological response. However, one year later, while she was receiving her second infusion, she suddenly developed severe hypotension, cough, dysphagia and diffuse urticaria/angioedema. She was then treated with intravenous corticosteroids, antihistamines and fluids. Four months later, 1:1000 intradermal tests with ALEM were strongly positive at 20' reading. We have carried out other intradermal tests in 5 MS patients treated with alem in order to ruled out a hypersensitivity to other molecules. All tests results negative. A diagnosis of IgE-mediated anaphylaxis to ALEM was then confirmed. Since no other effective alternatives were available to treat her MS, ALEM was infused following Castells' desensitization protocol. No mild or severe AE were observed. The treatment was effective with regard to disease activity and quality of life improvement.
Conclusions: This is the first case of ALEM-desensitization in a MS patient. This procedure allowed a safe administration of the only effective treatment for this highly active patient, despite her previous severe IR to the drug. Desensitization is a crucial procedure to induce temporary drug tolerance, when no effective alternatives are available.
Disclosure: L. Moiola: has received honoraria from Biogen, Merck-Seron,Sanofi-Genzyme,Novartis
TEVA
M. Romeo: nothing to disclose
M. Di Cristinzi: nothing to disclose
GA Ramirez: nothing to disclose
V. Martinelli: has received speaking fees and/or travel expenses from Biogen-Dompe` SG, Merck Serono, Bayer Schering, Novartis, Sanofi-Aventis, Genzyme Europe, Teva
L. Dagna: nothing to disclose
G. Comi: has received compensation for consulting services and /or for speaking activities from Novartis, Teva, Sanofi, Genzyme, Merck, Biogen, Excemed, Roche, Almirall, Celgene, Forward Pharma, Medday.
M.R Yacoub: nothing to disclose
Abstract: EP1716
Type: Poster Sessions
Abstract Category: Therapy - Others
Background: Alemtuzumab(ALEM) is a highly effective monoclonal anti-CD52 antibody approved for patients with active multiple sclerosis(MS). The most common ALEM's adverse events(AE) are infusion reactions(IRs). Three out of 100 IRs are severe and contraindicate treatment prosecution with the traditional schedule.
Methods: a case report
Results: a 45-year-old female, diagnosed with MS in 1998, was treated with several therapies, but only had a complete response to natalizumab. However, natalizumab had been discontinued for a high progressive multifocal leucoencephalopathy risk. After last treatment failure with fingolimod, she was started on ALEM without any AE and with an optimal clinical and neuroradiological response. However, one year later, while she was receiving her second infusion, she suddenly developed severe hypotension, cough, dysphagia and diffuse urticaria/angioedema. She was then treated with intravenous corticosteroids, antihistamines and fluids. Four months later, 1:1000 intradermal tests with ALEM were strongly positive at 20' reading. We have carried out other intradermal tests in 5 MS patients treated with alem in order to ruled out a hypersensitivity to other molecules. All tests results negative. A diagnosis of IgE-mediated anaphylaxis to ALEM was then confirmed. Since no other effective alternatives were available to treat her MS, ALEM was infused following Castells' desensitization protocol. No mild or severe AE were observed. The treatment was effective with regard to disease activity and quality of life improvement.
Conclusions: This is the first case of ALEM-desensitization in a MS patient. This procedure allowed a safe administration of the only effective treatment for this highly active patient, despite her previous severe IR to the drug. Desensitization is a crucial procedure to induce temporary drug tolerance, when no effective alternatives are available.
Disclosure: L. Moiola: has received honoraria from Biogen, Merck-Seron,Sanofi-Genzyme,Novartis
TEVA
M. Romeo: nothing to disclose
M. Di Cristinzi: nothing to disclose
GA Ramirez: nothing to disclose
V. Martinelli: has received speaking fees and/or travel expenses from Biogen-Dompe` SG, Merck Serono, Bayer Schering, Novartis, Sanofi-Aventis, Genzyme Europe, Teva
L. Dagna: nothing to disclose
G. Comi: has received compensation for consulting services and /or for speaking activities from Novartis, Teva, Sanofi, Genzyme, Merck, Biogen, Excemed, Roche, Almirall, Celgene, Forward Pharma, Medday.
M.R Yacoub: nothing to disclose