Pulmonary <i>Nocardia beijingensis</i> infection associated with the use of alemtuzumab in a patient with multiple sclerosis

Sheikh-Taha, Marwan; Corman, Lourdes C.

doi:10.1177/1352458517694431

Cited by 40 publications

(17 citation statements)

References 8 publications

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“…In the United States (US), a rare pathogen, Nocardia beijingensis , was isolated from a patient diagnosed with sepsis secondary to pneumonia 6 weeks after completing the first course of alemtuzumab; the patient responded well to treatment. 46 Finally, several cases of Listeria monocytogenes infection have been reported. In one case, the patient had recent exposure to foods including smoked sausage and soft cheese and developed Listeria septicemia after the initial alemtuzumab infusion.…”

Section: Safety In Long-term Clinical Trials and In Real-world Experimentioning

confidence: 99%

Alemtuzumab in the long-term treatment of relapsing-remitting multiple sclerosis: an update on the clinical trial evidence and data from the real world

Ziemssen

Thomas

2017

Ther Adv Neurol Disord

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Alemtuzumab is a humanized monoclonal antibody approved for the treatment of relapsing-remitting multiple sclerosis (RRMS), given as two annual courses on five consecutive days at baseline and on three consecutive days 12 months later. Here we provide an update on the long-term efficacy and safety of alemtuzumab in RRMS, including real-world experience, and advances in our understanding of its mechanism of action. Recent data from the phase II/III extension study have demonstrated that alemtuzumab reduces relapse rates, disability worsening, and the rate of brain volume loss over the long term, with many patients achieving no evidence of disease activity. In high proportions of patients, preexisting disability remained stable or improved. Alemtuzumab is associated with a consistent safety profile over the long term, with no new safety signals emerging and the overall annual incidence of reported adverse events decreasing after the first year on treatment. Acyclovir prophylaxis reduces herpetic infections, and monitoring has been shown to mitigate the risk of autoimmune adverse events, allowing early detection and overall effective management. Data from clinical practice and ongoing observational studies are providing additional information on the real-world use of alemtuzumab. Recent evidence on the mechanism of action of alemtuzumab indicates that in addition to its previously known effects of inducing depletion and repopulation of T and B lymphocytes, it also results in a relative increase of cells with memory and regulatory phenotypes and a decrease in cells with a proinflammatory signature, and may further promote an immunoregulatory environment through an impact on other innate immune cells (e.g. dendritic cells) that play a role in MS. These effects may allow preservation of innate immunity and immunosurveillance. Together, these lines of evidence help explain the durable clinical efficacy of alemtuzumab, in the absence of continuous treatment, in patients with RRMS.

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Section: Safety In Long-term Clinical Trials and In Real-world Experimentioning

confidence: 99%

Alemtuzumab in the long-term treatment of relapsing-remitting multiple sclerosis: an update on the clinical trial evidence and data from the real world

Ziemssen

Thomas

2017

Ther Adv Neurol Disord

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“…, called Nocardia beijingesis , was reported in a woman after alemtuzumab treatment. The woman recovered after intravenous antibiotic therapy (meropenem) 25. No cases of progressive multifocal leukoencephalopathy have been reported in RRMS patients treated with alemtuzumab.…”

Section: Methodsmentioning

confidence: 95%

“…In fact, the effects of live viral vaccines on the immune system after treatment with alemtuzumab are yet to be evaluated. Several cases of opportunistic infections, such as listeria meningitis, were reported 7,25. A single case of cerebral nocardiosis in a woman treated with alemtuzumab for RRMS was also observed 24.…”

Section: Methodsmentioning

confidence: 98%

Alemtuzumab: a review of efficacy and risks in the treatment of relapsing remitting multiple sclerosis

Guarnera¹,

Bramantı²,

Mazzon³

2017

TCRM

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Alemtuzumab is a selective humanized monoclonal antibody directed against the CD52 antigen, and has been found to be a powerful treatment for relapsing remitting multiple sclerosis. Alemtuzumab demonstrated high efficacy in several clinical studies. The risk of relapse and sustained accumulation of disability showed significant reduction in the Phase II CAMMS223 and the Phase III clinical trials CARE MS I and CARE MS II. The data presented at the 32nd Congress of the European Committee for Treatment and Research in Multiple Sclerosis confirmed these results. After completion of a 1-year treatment cycle, alemtuzumab showed a sustained effect. Although the efficacy of alemtuzumab has been widely proven, several severe adverse effects have been reported with its use. Infusion-associated reactions, increased risk of infections, and secondary autoimmunity have been associated with alemtuzumab. Autoimmune disease – mainly of the thyroid – has been reported. Immune thrombocytopenic purpura and autoimmune nephropathies have been observed less frequently. These adverse effects, given the short period of alemtuzumab marketing for relapsing remitting multiple sclerosis, require strict monitoring.

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“…14 Administration of live vaccines is not recommended since effects are yet to be further investigated. 14 In MS, listeria meningitis was also reported in several cases with alemtuzumab 24 mg, 57 – 59 such as single cases of cerebral nocardiosis, 60 and Nocardia beijingesis . 58 In two pivotal studies, one case was reported in the CAMMS223 study, 56 and two cases in another study.…”

Section: Alemtuzumab: T and B Cell Depleting Therapy For Rrmsmentioning

confidence: 99%

“…14 In MS, listeria meningitis was also reported in several cases with alemtuzumab 24 mg, 57 – 59 such as single cases of cerebral nocardiosis, 60 and Nocardia beijingesis . 58 In two pivotal studies, one case was reported in the CAMMS223 study, 56 and two cases in another study. 59 Dietary restriction of food such as unpasteurized milk and raw milk, a month before treatment with alemtuzumab was recommended to reduce the infection risk among patients.…”

Section: Alemtuzumab: T and B Cell Depleting Therapy For Rrmsmentioning

confidence: 99%

The use of alemtuzumab in patients with relapsing-remitting multiple sclerosis: the Gulf perspective

Alroughani

Wijmeersch

Khaboori

et al. 2020

Ther Adv Neurol Disord

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Over the past decade, the development of high-efficacy disease-modifying therapies (DMTs) has been responsible for more effective management of relapsing-remitting multiple sclerosis (RRMS). However, the gaps in optimal care for this complex disease remain. Alemtuzumab (Lemtrada®) is a highly efficacious DMT that shows better patient outcomes and therapeutic benefits, but its use is under-recognized in the Gulf region. Experts in the care of multiple sclerosis shared their opinions based on study data and daily clinical experience in identifying the appropriate patient profile suitable for alemtuzumab’s therapeutic benefits. Age, disease activity and severity, disability status, physician experience, and economic condition are some of the key indicators for alemtuzumab use.

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Pulmonary Nocardia beijingensis infection associated with the use of alemtuzumab in a patient with multiple sclerosis

Cited by 40 publications

References 8 publications

Alemtuzumab in the long-term treatment of relapsing-remitting multiple sclerosis: an update on the clinical trial evidence and data from the real world

Alemtuzumab in the long-term treatment of relapsing-remitting multiple sclerosis: an update on the clinical trial evidence and data from the real world

Alemtuzumab: a review of efficacy and risks in the treatment of relapsing remitting multiple sclerosis

The use of alemtuzumab in patients with relapsing-remitting multiple sclerosis: the Gulf perspective

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