How Lemtrada Works in Multiple Sclerosis
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- เผยแพร่เมื่อ 25 ก.ค. 2024
- Alemtuzumab (Lemtrada) works to treat Multiple Sclerosis differently than all the other MS disease modifying therapies. In this video I explain it to you.
Lemtrada is not a pill nor a shot, it's infused via an IV. It's a monoclonal antibody. Think of these monoclonal antibodies as a "smart bomb" that can find one specific type of cell in the body and kill it, while leaving the rest of the cells of the body completely alone.
Lemtrada is a "smart bomb" that binds and kills only cells that express a certain "hang tag" or "sign" called CD52. CD52 is expressed on ADULT B and T cells only. Lemtrada therefore doesn't kill other cell lines, and it doesn't kill the pleuripotent stem cells. This last part is important because of what happens next.
After Lemtrada kills the adult B and T cells, the pleuripotent stem cells start to grow up...BUT THEY GROW UP DIFFERENTLY! The regulatory T cells seem to grow back BIGGER and MORE ACTIVE. In this way it seems that Lemtrada tries to "reset" your immune response.
It's this "reset" that, to me, explains WHY we see durable disease suppression even though most aren't re-treated after the 1st year.
Lemtrada is given in 2 courses, separated by 12 months. The 1st course involves 5 days of IV infusions. Then a year later the 2nd course only involves 3 days of infusions. We generally DON'T re-dose with a 3rd course UNLESS the person suffers a new MS attack or 2 new MRI lesions following the 2nd course.
Unlike almost all other MS DMTs, Lemtrada is a form of Induction Therapy. We induce changes in the immune response up front, and thereby attempt to change the long term course of the disease via this early "course correction".
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Learn about MS with me, Aaron Boster MD! I started this channel to help my own MS patients learn between clinic visits. I use easy-to-understand language to provide accurate and approachable Multiple Sclerosis education. So, if you’re impacted by MS and want to up your game, make sure to subscribe to my channel right now!
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These videos do not provide medical advice and are for informational/educational purposes only. The videos are not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or seen in any of our videos.
Best explanation I've heard. Thank you for this video.
Yes, this information was amazing. I know there are lucky discoveries, but I was amazed how it was originally for cancer.
this explanation has made sense of all the thing i knew about lemtrada from being a patient. learning that lemtrada leaves the system within the first month makes so much sense because the first month was incredibly hard for me. i switched to lemtrada from tysabri and i was used to feeling really bad the week leading up to my infusion, so i equated r1 of lem to be similar. it really did take about a month to a month and a half after r1 before i started feeling more like myself.
I just had round 3 lemtrada. Thank you for this x
Thank you for your highly understandable and descriptive explanation. I was having trouble grasping Lemtrada and how it worked. Now I understand. Thank you.
Currently on Tysabri and JCV negative, love it 2.5 years (no relapses and MRI is "stable" and potentially based on my doctor wants to move to Lemtrada. I enjoy your videos, you make the disease and drugs understandable to the patient. Thank you
what a great explanation! thank you
I cannot thank you enough for this explanation. I'm so glad I found this and your channel. I think way too many patients are ill informed, or just in the dark about ms and treatment. I want to help others like you helped me Dr. B. Lemtrada changed my life and you and Dr. Nicholas saved my life. Cannot thank you enough!
#WeHaveMS!
I just finished Lemtrada and during and after Is nothing like what people were saying ! If you do what you’re told everything will go smoothly. I barely even have any pain. If I had to do it all over again I’d definitely do it. Thank you for your videos
Congrats!
Thank you for this info. I really want to meet you and see if you can help me.
Hi Dr. Boster from Illinois! I met with my State Senator yesterday for MS Action Day with the NMSS. She asked, "How do they (drug companies) come up with these names?" I said, "Let me tell you about Lemtrada." I refemce you video and told her. Thank you for this easy explanation of alemtuzumab!
That's totally awesome! TY for sharing James!
Thank you so much, no one really ever explained what I was pumping into my body 11 years ago but this explanation was so clear. Everyone always says campath is a chemotherapy, can you tell me if this is right?
This is the best explanation of Lemtrada that I've heard. I'm curious to know your thoughts on thyroid issues as a side effect to its use, in particular thyroid cancer.
re: autoimmune thyroid disorders: Over 7 years there is ~41% chance of an autoimmune thyroid problem (hyper or hypo). We've treated over 200 PwMS at our center and have seen our fair share. They are most often very easy to manage. We send them to a wonderful endocrinologist who has been fantastic. It's not good to have a thyroid problem, but it's good that it's easily treatable in most cases.
re: thyroid cancer: Risk of thyroid cancer in the studies is 0.3%, which is actually the same risk in the general MS population. All were caught using labs, all were resected successfully (no more cancer).
Also here is a video I did on Lemtrada safety monitoring: th-cam.com/video/nBiAW4mxCNo/w-d-xo.html
@@AaronBosterMD So should a PwMS already having Hypothyrodism (in my case on thyroxine 75mcg) should opt for Alemtuzumab ?
Dr Boster, can you review and post a video regarding the recent FDA warning about ischemic stroke from Lemtrada? Thank you.
That is a great idea. Speaking from experience, the take home is very simple: I believe strongly that appropriate blood pressure management during the infusion can mitigate the risk.
Great! Thank you. I would love to hear the difference between how Rituxan works and how Lemtrda works.
Carol,
Do you mean differences mechanistically in how the molecules alter immune response to alter the damage of MS, or more the differences philosophically and medically that would lead someone to use one drug over the other drug?
Explanation of both please.
You are a hero =)
I'm just trying to help best I can Numan!
Thank you for your informative video. I have rrms and was just approved for Lemtrada. I am just terrified that I could have an adverse effect to the infusion, such as a stroke, because I have high blood pressure. I also worry because my body doesn’t seem to respond typically to other medicines. For instance my white cell counts don’t seem to drop after Solu-Medrol. I just don’t want to possibly die trying to keep this MonSter under control.
1. congrats on embarking on such a highly effective MS therapy
2. IMO as long as your BP is properly monitored during the infusion you'll be ok
3. How your body responds to 1 med is not predictive of how it will respond to another
4. you got this AVi. #MSWarrior!
Thank you Dr.B for this info about the Lemtrada I need to try something, I just have alot of complications with alot of the MS meds an it scares me because of the side effects , which my MS Docs agree not to try this an I'm in my secondary progressive so is there anyway I can talk about this I would love to see if I could change my Dr . from Worc to u any info u can give me ? Help Please
I have made several videos on this channel on these topics, intended to help you in exactly this way. I hope that you find them useful!
Lemtrada therapy looks very interesting! That could work with Benign MS, no matter how old you are.
Unfortunately for PwMS in the united states, the FDA has recommended Lemtrada be used 3rd line (as compared to 1st line in aggressive MS in EU, 1st line Australia, 2nd line Canada). American insurance companies often interpret the FDA recommendation as gospel and dis-allow use prior to "failing 2 other therapies". This often delays access to this highly effective therapy ;(
Re Ocrevus destroying B cells: Do people with MS have too many B cells? Or the B cells are malfunctioning? Or the T cells are malfunctioning, with B cells enabling them? Is there any negative effect from losing B cells?
You've described my immune system to a T (groan). I have very little functional immune system (Tcop). Can you explain WHY the good immune system grows back more quickly? I've been told this is likely my next option but my neurologist is very hesitant.
Karen, I'm not sure WHY the "baby B and T cells" grow back with a larger and more active regulatory component. The data is pretty clear that it happens, but I'm not sure (don't know if anyone knows) why.
After 4 days in the hospital with a relapse - Lemtrada was suggested. I have a heart thing. But I am 44. I am scared. I am tired of being scared. I watch your videos to help and thank you for that. The stroke risk is what scares O and I had a bad reaction. Thank you for the video.
LEMTRADA-PREGNANCY? Hello Doctor ~ thank you for your videos ~
I'm Joanna , 32 years old lady from Greece. It's been 10 years having MS and latest 5 years i receive no treatment. Now I'm thinking about Lemtrada ( I've tried Rebif, Copaxone, Betaferon, Tysabri ). I'm wondering how Lemtrada could affect me if i get pregnant.. I think all young ladies who suffer from MS are thinking about it.. As a woman i want to be able to make a family and have children. Of course i want to protect myself from MS but i don't want because of that to grow old alone :/
It's generally considered safe to conceive a child 4 months after a course of lemtrada, which creates an interesting situation: the PwMS is "treated" and "protected" BUT they are not on a medicine that risks fetal injury. Very cool in that regard IMHO.
Where is your clinic doctor ? How can we contact with you please
Our clinic is in Columbus Ohio in the mid western United States. We see patients from all over. And if you would like more information please check out our website at www.OhioHealth.com/MS
Our clinic is in Columbus Ohio in the mid western United States. We see patients from all over. And if you would like more information please check out our website at www.OhioHealth.com/MS
Aaron Boster MD we will try to get a visa we are from Saudi Arabia , but give us a hope is there any new tretment ?! Cause she my sister tried interferon and gelynia
I am now scheduled to get lem next month on the 23rd
AWESOME!
Yea, but it’s normal to be scared or worried right
Totally normal aSChubbz!
I am 1 month post round 2. Have you seen patients that don’t have their CD4 drop after round 2? Mine was 214 one month prior to round 2. Now they came back at 344. My concern is that my body didn’t respond to this round as it should have.
That does not sound concerning to my ears. I would not predict success based on that nadir.
Aaron Boster MD thank you. I’ve been worrying about it and haven’t heard back from my neurologist yet
glad to hear you're checking with your provider Ijw!
There are more Tregs after treatment, but how exactly are the lymphocytes themselves different?
lymphocytes are a type of white blood cell. T regs are a type of lymphocyte. It appears that the number and function of T regs seems BIGGER after induction therapy.
Aaron Boster MD Thanks Aaron. I've just given this video another watch.
Are the lymphocytes different once they return (replenished) over time? If so, how? How exactly are they different than before treatment? What's different about the new ones?
will this work for rrms and how can I get this
In and out dives yes
1 more day left of rd 1
congrats aSChubbz! #MSWarrior
Finished lemtrada today with a make up day
congrats!
Sorry but what do you mean by “the vast majority of them have quiet disease”?
no attacks, no new lesions on MRI, no change on their neuro examinations.
Aaron Boster MD - So, basically it appears to be a cure, but no one wants to call it that because we don’t have enough years of data on Lemtrada in MS patients? Plus, I’m assuming it doesn’t help with remyelination of previously damaged nerve and brain cells? Fascinating stuff!
So this is a form of HSCT
Think of a HSCT as a hard reboot of the immune system. Think of Lemtrada as a soft reboot. They are similar in some ways, you're right ham.
Holy shit it's him
Your videos saved me from severe depression I just got diagnosed with Ms a few weeks ago
wow I'm super glad you are feeling better Ham! I hope you find the videos helpful. I try to publish one each weekend!
What are your thoughts on HSCT,DrB?
You're too far from the camera.
Hope it's gotten better recently?