Alemtuzumab improves neurological functional systems in treatment-naive relapsing-remitting multiple sclerosis patients

Background: Individual functional system scores (FSS) of the Expanded Disability Status Scale (EDSS) play a central role in determining the overall EDSS score in patients with early-stage multiple sclerosis (MS). Alemtuzumab treatment improves preexisting disability for many patients; however, it is unknown whether improvement is specific to certain functional systems. Objective: We assessed the effect of alemtuzumab on individual FSS of the EDSS. Methods: CAMMS223 was a 36-month, rater-blinded, phase 2 trial; treatment-naive patients with active relapsing-remitting MS, EDSS <= 3, and symptom onset within 3 years were randomized to annual courses of alemtuzumab or subcutaneous interferon beta-la (SC IFNB-1a) 44 mu g three times weekly. Results: Alemtuzumab-treated patients had improved outcomes versus SC IFNB-1 a patients on most FSS at Month 36; the greatest effect occurred for sensory, pyramidal, and cerebellar FSS. Among patients who experienced 6 month sustained accumulation of disability, clinical worsening occurred most frequently in the brainstem and sensory systems. For patients with 6-month sustained reduction in preexisting disability, pyramidal and sensory systems contributed most frequently to clinical improvement. Conclusions: Alemtuzumab demonstrated a broad treatment effect in improving preexisting disability. These findings may influence treatment decisions in patients with early, active relapsing-remitting MS displaying neurological deficits. (C) 2016 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license.