Immune reconstitution and treatment response in multiple sclerosis following alemtuzumab

Monoclonal antibodies have rapidly developed as an important therapeutic strategy in multiple sclerosis (MS). As a result of an improved understanding of pathogenesis, a number of agents are now in the latter stages of development, which may allow a more targeted approach to forms of this disease resistant to other treatments. Alemtuzumab is the second to emerge for treatment of relapsing MS and has had a long and occasionally painful evolution toward wider availability. Even now it continues to court controversy, having been approved for use in Europe but, to the dismay of many specialists, let alone patients, having so far been denied a license in the United States, the US Food and Drug Administration (FDA) citing concerns about blinding in trial designs and frequency of adverse events.(1,2</SUP)