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Management of infusion related reactions associated with alemtuzumab in patients with multiple sclerosis.
Mult Scler Relat Disord. 2017 Oct; 17:151-153.MS

Abstract

OBJECTIVE

Infusion-associated reactions (IARs) occur in >90% patients with multiple sclerosis (MS) treated with alemtuzumab. We aimed to study the frequency of IARs at 2 sites using 5 days of steroids (1g/day of IV methylprednisolone), but otherwise distinct protocols.

METHODS

This was retrospective chart review of 38 consecutive MS patients who were treated with alemtuzumab from June 2015 till February 2017 at Department of Neurology, University Hospital Center Zagreb, Croatia and Department of Neurology, University Medical Center Ljubljana, Slovenia.

RESULTS

Seventeen patients (44.7%) did not experience IARs. Skin reactions and fever were the most common IARs attributed to alemtuzumab infusions and they were most frequent on Day 5 and Day 1, respectively. We have observed significant differences in the occurrence of fever (p = 0.005) depending on the site of alemtuzumab administration which could be explained by different antipyretics used; fever was absent in the Slovenian cohort because high dose intravenous metamizole was administered. Two out of 9 treatment naïve, and 19 out of 29 patients who previously received immunomodulatory treatment had IARs (χ2 = 5.208, p = 0.022).

CONCLUSION

Modified premedication scheme consisting of 1g/day of IV methylprednisolone throughout all 5 days of alemtuzumab treatment may reduce overall IARs. Intravenous administration of antipyretics may work better than oral administration.

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Authors+Show Affiliations

Šega-Jazbec S
Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Barun B
Department of Neurology, University Hospital Center Zagreb, Zagreb, Croatia.
Horvat Ledinek A
Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Fabekovac V
Department of Neurology, University Hospital Center Zagreb, Zagreb, Croatia.
Krbot Skorić M
Department of Neurology, University Hospital Center Zagreb, Zagreb, Croatia.
Habek M
Department of Neurology, University Hospital Center Zagreb, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia. Electronic address: mhabek@mef.hr.

MeSH

Administration, IntravenousAdministration, OralAdultAlemtuzumabAnti-Inflammatory AgentsDisability EvaluationFemaleHumansImmunologic FactorsMaleMethylprednisoloneMultiple Sclerosis, Relapsing-RemittingRetrospective StudiesTime FactorsTreatment Outcome

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

29055450

Citation

Šega-Jazbec, Saša, et al. "Management of Infusion Related Reactions Associated With Alemtuzumab in Patients With Multiple Sclerosis." Multiple Sclerosis and Related Disorders, vol. 17, 2017, pp. 151-153.
Šega-Jazbec S, Barun B, Horvat Ledinek A, et al. Management of infusion related reactions associated with alemtuzumab in patients with multiple sclerosis. Mult Scler Relat Disord. 2017;17:151-153.
Šega-Jazbec, S., Barun, B., Horvat Ledinek, A., Fabekovac, V., Krbot Skorić, M., & Habek, M. (2017). Management of infusion related reactions associated with alemtuzumab in patients with multiple sclerosis. Multiple Sclerosis and Related Disorders, 17, 151-153. https://doi.org/10.1016/j.msard.2017.07.019
Šega-Jazbec S, et al. Management of Infusion Related Reactions Associated With Alemtuzumab in Patients With Multiple Sclerosis. Mult Scler Relat Disord. 2017;17:151-153. PubMed PMID: 29055450.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of infusion related reactions associated with alemtuzumab in patients with multiple sclerosis. AU - Šega-Jazbec,Saša, AU - Barun,Barbara, AU - Horvat Ledinek,Alenka, AU - Fabekovac,Višnja, AU - Krbot Skorić,Magdalena, AU - Habek,Mario, Y1 - 2017/07/19/ PY - 2017/04/05/received PY - 2017/06/16/revised PY - 2017/07/18/accepted PY - 2017/10/23/entrez PY - 2017/10/23/pubmed PY - 2018/6/8/medline KW - Alemtuzumab KW - Infusion associated reactions KW - Multiple sclerosis SP - 151 EP - 153 JF - Multiple sclerosis and related disorders JO - Mult Scler Relat Disord VL - 17 N2 - OBJECTIVE: Infusion-associated reactions (IARs) occur in >90% patients with multiple sclerosis (MS) treated with alemtuzumab. We aimed to study the frequency of IARs at 2 sites using 5 days of steroids (1g/day of IV methylprednisolone), but otherwise distinct protocols. METHODS: This was retrospective chart review of 38 consecutive MS patients who were treated with alemtuzumab from June 2015 till February 2017 at Department of Neurology, University Hospital Center Zagreb, Croatia and Department of Neurology, University Medical Center Ljubljana, Slovenia. RESULTS: Seventeen patients (44.7%) did not experience IARs. Skin reactions and fever were the most common IARs attributed to alemtuzumab infusions and they were most frequent on Day 5 and Day 1, respectively. We have observed significant differences in the occurrence of fever (p = 0.005) depending on the site of alemtuzumab administration which could be explained by different antipyretics used; fever was absent in the Slovenian cohort because high dose intravenous metamizole was administered. Two out of 9 treatment naïve, and 19 out of 29 patients who previously received immunomodulatory treatment had IARs (χ2 = 5.208, p = 0.022). CONCLUSION: Modified premedication scheme consisting of 1g/day of IV methylprednisolone throughout all 5 days of alemtuzumab treatment may reduce overall IARs. Intravenous administration of antipyretics may work better than oral administration. SN - 2211-0356 UR - https://www.unboundmedicine.com/medline/citation/29055450/Management_of_infusion_related_reactions_associated_with_alemtuzumab_in_patients_with_multiple_sclerosis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2211-0348(17)30178-5 DB - PRIME DP - Unbound Medicine ER -