Figuring Out Who Will Benefit Most From A New Therapy For Multiple Sclerosis

Main Category: Multiple Sclerosis
Article Date: 23 Jun 2009 - 5:00 PDT

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In a recent phase II clinical trial, the drug alemtuzumab (Campath-1H) was found to be a highly effective treatment for individuals with early relapsing-remitting multiple sclerosis. However, a substantial proportion of the patients treated (30%) went on to develop another autoimmune disease, mostly thyroid autoimmunity. Now, Joanne Jones and colleagues, at the University of Cambridge, United Kingdom, have determined that individuals with higher levels of the soluble factor IL-21 in their blood prior to alemtuzumab treatment were those that went on to develop an autoimmune disease. Further analysis identified a mechanism by which IL-21 contributes to the development of autoimmunity and determined that in some patients the higher levels of IL-21 were genetically predetermined. The authors therefore suggest that measuring levels of IL-21 in the blood of individuals with early relapsing-remitting multiple sclerosis might identify those that would be at greatest risk of developing autoimmunity if treated with alemtuzumab. Terri Laufer and Gregory Wu, at the University of Pennsylvania, Philadelphia, further discuss the importance of this in an accompanying commentary, noting that determining one reason why some patients succumb to autoimmune disease after alemtuzumab treatment, while others do not, is likely to increase enthusiasm for this new therapeutic.

TITLE: IL-21 drives secondary autoimmunity in patients with multiple sclerosis, following therapeutic lymphocyte depletion with alemtuzumab (Campath-1H)

AUTHOR CONTACT:
Joanne L. Jones
University of Cambridge, Addenbrooke's Hospital,
Cambridge, United Kingdom.

View the PDF of this article at: https://www.the-jci.org/article.php?id=37878

ACCOMPANYING COMMENTARY
TITLE: Treating MS: getting to know the two birds in the bush

AUTHOR CONTACT:
Terri M. Laufer
University of Pennsylvania, Philadelphia,
Pennsylvania, USA.

View the PDF of this article at: https://www.the-jci.org/article.php?id=39963

Source:
Karen Honey
Journal of Clinical Investigation