Role of monoclonal antibodies in Multiple Sclerosis
What is the role of monoclonal antibodies for the treatment of Multiple Sclerosis?
Nataluzimab (Tysabri) is a monoclonal antibody given by monthly intravenous infusions.
It is directed against alpha-1-integrin on the blood–brain barrier and prevents T cells from leaving the circulation and entering the central nervous system, thus reducing attacks on the myelin.
Because it also reduces T-cell immune surveillance in the brain, the rate of opportunistic infections is increased, especially from progressive multifocal leukoencephalopathy.
Patients are thus carefully screened (with JC virus antibodies and MRI scans) and followed before and during treatment.
Alemtuzumab (Lemtrada) is a monoclonal antibody directed against CD52 receptors on monocytes that effectively depletes circulating lymphocytes.
It is given intravenously over 5 consecutive days and then repeated for 3 days 1 year later.
Its potentially serious toxicity includes development of other autoimmune disorders such as thyroid disease and thrombocytopenia.