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Alemtuzumab versus interferon beta 1a as first-line treatment for patients with relapsing-remitting multiple sclerosis: a randomised controlled phase 3 trial
Abstract
Background The anti-CD52 monoclonal antibody alemtuzumab reduced disease activity in a phase 2 trial of previously untreated patients with relapsing-remitting multiple sclerosis. We aimed to assess efficacy and safety of first-line alemtuzumab compared with interferon beta 1a in a phase 3 trial.Methods In our 2 year, rater-masked, randomised controlled phase 3 trial, we enrolled adults aged 18-50 years with previously untreated relapsing-remitting multiple sclerosis. Eligible participants were randomly allocated in a 2:1 ratio by an interactive voice response system, stratified by site, to receive intravenous alemtuzumab 12 mg per day or subcutaneous interferon beta 1a 44 μg. Interferon beta 1a was given three-times per week and alemtuzumab was given once per day for 5 days at baseline and once per day for 3 days at 12 months. Coprimary endpoints were relapse rate and time to 6 month sustained accumulation of disability in all patients who received at least one dose of study drug. This study is registered with ClinicalTrials.gov, number NCT00530348.Findings 187 (96%) of 195 patients randomly allocated interferon beta 1a and 376 (97%) of 386 patients randomly allocated alemtuzumab were included in the primary analyses. 75 (40%) patients in the interferon beta 1a group relapsed (122 events) compared with 82 (22%) patients in the alemtuzumab group (119 events; rate ratio 0·45 [95% CI 0·32-0·63]; p<0.0001), corresponding to a 54·9% improvement with alemtuzumab. Based on Kaplan-Meier estimates, 59% of patients in the interferon beta 1a group were relapse-free at 2 years compared with 78% of patients in the alemtuzumab group (p<0·0001). 20 (11%) of patients in the interferon beta 1a group had sustained accumulation of disability compared with 30 (8%) in the alemtuzumab group (hazard ratio 0·70 [95% CI 0·40-1·23]; p=0·22). 338 (90%) of patients in the alemtuzumab group had infusion-associated reactions; 12 (3%) of which were regarded as serious. Infections, predominantly of mild or moderate severity, occurred in 253 (67%) patients treated with alemtuzumab versus 85 (45%) patients treated with interferon beta 1a. 62 (16%) patients treated with alemtuzumab had herpes infections (predominantly cutaneous) compared with three (2%) patients treated with interferon beta 1a. By 24 months, 68 (18%) patients in the alemtuzumab group had thyroid-associated adverse events compared with 12 (6%) in the interferon beta 1a group, and three (1%) had immune thrombocytopenia compared with none in the interferon beta 1a group. Two patients in the alemtuzumab group developed thyroid papillary carcinoma.Interpretation Alemtuzumab's consistent safety profile and benefit in terms of reductions of relapse support its use for patients with previously untreated relapsing-remitting multiple sclerosis; however, benefit in terms of disability endpoints noted in previous trials was not observed here.Funding Genzyme (Sanofi) and Bayer Schering Pharma.
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“In the phase III clinical trials comparing alemtuzumab with interferon β-1a in highly active MS, no overall increase in malignancy was observed;”
From 2019 European Thyroid Association Guidelines on the Management of Thyroid Dysfunction following Immune Reconstitution Therapy (2019) · cites this paper as [60]
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“however, papillary thyroid cancer was discovered in 0.4% of alemtuzumab-treated patients [59, 60].”
From 2019 European Thyroid Association Guidelines on the Management of Thyroid Dysfunction following Immune Reconstitution Therapy (2019) · cites this paper as [60]
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Filippi, M., Bar-Or, A., Piehl, F., Preziosa, P., Solari, A., Vukusic, S., & Rocca, M. A. (2018) · Nature Reviews Disease Primers · doi:10.1038/s41572-018-0041-4 · Cited by 1,562
Diagnosis and Treatment of Multiple Sclerosis: A Review
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Self-citationMultiple Sclerosis: Current Knowledge and Future Outlook
Kamm, C. P., Uitdehaag, B. M. J., & Polman, C. H. (2014) · European Neurology · doi:10.1159/000360528 · Cited by 1,011
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Hauser, S. L., & Cree, B. A. C. (2020) · The American Journal of Medicine · doi:10.1016/j.amjmed.2020.05.049 · Cited by 969
Metadata
- Authors
- Cohen, J. A., Coles, A. J., Arnold, D. L., Confavreux, C., Fox, E. J., Hartung, H.-P., Havrdova, E., Selmaj, K. W., Weiner, H. L., Fisher, E., Brinar, V. V., Giovannoni, G., Stojanovic, M., Ertik, B. I., Lake, S. L., Margolin, D. H., Panzara, M. A., & Compston, D. A. S.
- Affiliations
- Cleveland Clinic (US)
- University of Cambridge (GB)
- Montreal Neurological Institute and Hospital (CA)
- Lyon 1 Université (FR)
- Central Texas Neurology Consultants (US)
- Heinrich Heine University Düsseldorf (DE)
- Medical University of Lodz (PL)
- Brigham and Women's Hospital (US)
- University Hospital Centre Zagreb (HR)
- Queen Mary University of London (GB)
- Clinical Centre of Kragujevac (RS)
- Corresponding author
- Cohen, Jeffrey A
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2012-11
- Volume
- 380
- Issue
- 9856
- Pages
- 1819-1828
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2148766438
- Cited by
- 1,205
- References
- 39
- Citations by year
- 2026: 25 · 2025: 52 · 2024: 66 · 2023: 71 · 2022: 70 · 2021: 77 · 2020: 109 · 2019: 112 · 2018: 108 · 2017: 120 · 2016: 112 · 2015: 104 · 2014: 85 · 2013: 83 · 2012: 6
- FWCI
- 64.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- National Institute for Health and Care Research (NF-SI-0508-10335)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Hematology › Chronic Lymphocytic Leukemia Research
- Health Sciences › Medicine › Oncology › Polyomavirus and related diseases
- Keywords
- alemtuzumab, interferon beta-1a, relapsing-remitting multiple sclerosis, first-line therapy, anti-CD52 monoclonal antibody, relapse rate, disability progression, disease-modifying therapy, treatment safety, treatment-naive patients, relapse-free survival, time to treatment discontinuation, adverse events, immunosuppression
- MeSH terms
- Interferon beta-1a, Alemtuzumab, Adjuvants, Immunologic, Administration, Cutaneous, Adolescent, Adult, Female, Humans, Infusions, Intravenous, Male, Middle Aged, Recurrence, Treatment Outcome, Interferon-beta, Disease-Free Survival, Multiple Sclerosis, Relapsing-Remitting, Kaplan-Meier Estimate, Young Adult, Antibodies, Monoclonal, Humanized
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