Brands

• Lemtrada, Campath, MabCampath, Campath-1H

Generic?

• No

Class

• Immunosuppressant

Commonly Prescribed for

(FDA approved in bold)

• Relapsing forms of multiple sclerosis (MS)

• B-cell chronic lymphocytic leukemia (B-CLL)

• Induction therapy in organ transplantation

• Sporadic inclusion body myositis (sIBM)

How the Drug Works

• It is a humanized IgG1 kappa antibody that targets cell-surface glycoprotein CD52, which is expressed at a high level on T and B lymphocytes. Upon binding, it induces antibody-dependent cellular cytolysis and complement-mediated lysis of T and B lymphocytes. It particularly targets CD4+ naïve and CD8+ naïve T cells, and mature naïve B cells with proportional increase in regulatory T cells and memory T/B cells. Lymphocyte counts decrease after each course of treatment. Cells that escaped depletion may cause secondary autoimmunity. It also has prolonged decrease in the secretion of proinflammatory cytokines (interleukin [IL]-17, IL-22)

How Long Until It Works

• Months to years. In trials, treated patients had fewer relapses up to 2–5 years

If It Works

• Continue to use until ineffective. Screen for AEs

If It Doesn't Work

• It is the third-line treatment for relapsing forms of MS. If it fails, consider combination therapy with other diseasemodifying agents

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Acute MS attacks are often treated with glucocorticoids, especially if there is functional impairment due to vision loss, weakness, or cerebellar symptoms

• Treat common clinical symptoms with appropriate medication for spasticity (baclofen, tizanidine), neuropathic pain, and fatigue (modafinil)

• It is uncertain whether combined use of 2 types of antibodies or adding another disease-modifying agent is beneficial to MS

Tests

• CBC and platelet counts (monthly), thyroid function tests (every 3 months), and renal function (regularly) until 4 years after the last infusion. Yearly skin exams