Twenty-year-old drug 'best yet' for multiple sclerosis

It's been a long time coming. An antibody approved 20 years ago to treat leukaemia has proved in two large clinical trials to be the best therapy yet for multiple sclerosis.

Certain immune cells cause MS by attacking nerve cells. The drug works by temporarily destroying those immune cells. When they grow back, they no longer attack other cells. "It's like rebooting a computer," says Alasdair Coles from the University of Cambridge, who led one of the trials.

In both the two-year trials, the drug, alemtuzumab, outperformed the current standard treatment for the condition, called interferon beta-1a. "They are the best results in terms of effectiveness that have been seen in multiple sclerosis with any drug," says Coles.

He says that the number of disease relapses was around 50 per cent lower than in people on the standard drug. Brain scans showed that people taking alemtuzumab had 50 per cent fewer brain lesions than those on the standard treatment, and the rate of brain shrinkage ? typically 2 per cent per year in people with MS compared with 0.5 per cent in healthy people ? was restored to normal.

Off-label use

Sanofi, based in Paris, France, which manufactures alemtuzumab under the trade name Lemtrada, has applied for approval to sell the drug for treating MS in the US and Europe.

For the past decade, many people in the UK have been receiving alemtuzumab "off label", including professional golfer Tony Johnstone, who resumed his career after receiving the it. The company has temporarily withdrawn it from use for MS, while the approval process proceeds, and patients' groups such as the UK MS Society are urging the company not to raise the price of the drug exorbitantly should approval be granted, expected in June next year in Europe.

With respect to pricing in the UK, Genzyme, a Sanofi subsidiary that is applying for the approvals, says it will "engage constructively" with the National Health Service during the pricing process to ensure that, if approved, the drug will represent "good value for money".

Journal references: The Lancet, doi.org/jn3 and doi.org/jn4

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