Laboratory of Clinical Neurophysiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, Thessaloniki, 54636, Greece.
Department of Radiology, School of Medicine, University of Crete, Heraklion, Crete, 70013, Greece.
Mult Scler Relat Disord. 2020 Feb;38:101517. doi: 10.1016/j.msard.2019.101517. Epub 2019 Nov 11.
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.
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.
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.
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.
“侵袭性”和“高度活跃”的复发缓解型多发性硬化症的治疗仍然存在问题。尽管目前有许多高效的药物，但它们的最佳使用时机以及在疗效和即时及长期后果之间的平衡仍然是一个猜测的问题。
我们描述了 3 例多发性硬化症患者在芬戈莫德治疗下持续出现临床和放射学疾病活动的临床、放射学和免疫学特征。停用芬戈莫德后，患者出现严重疾病恶化，并成功接受了阿仑单抗治疗。
所有患者在接受阿仑单抗治疗后均有显著改善，并在中位随访 19 个月（范围：17-25 个月）后达到持续无疾病活动状态。所有病例均确认残疾改善。定量 MRI 数据显示，在 3 例患者中的 2 例中，T2 病变负荷减少，在所有患者中炎症活动完全消除。1 例患者在接受阿仑单抗治疗后出现了以前未报道的持续淋巴细胞增多症，与感染、淋巴增生性或自身免疫性疾病无关，且无明显的临床意义。
阿仑单抗似乎是一种有效和安全的短期治疗选择，既可以作为与停用芬戈莫德相关的疾病发作的挽救治疗，也可以逆转接受芬戈莫德治疗失败的患者观察到的病情恶化过程。
