Andy: What are the benefits and drawbacks to an infusion-based treatment?
Dr Helen Ford, Neurologist: So currently there are two infusion-based treatments which are licensed and available and they are natalizumab and alemtuzumab. The benefits of these treatments are that they’re highly effective treatments for MS, so in terms of reducing relapses, they reduce relapses by between 60 to 70%. The drawbacks really are in terms of the side effects and they’re different for the two drugs. So you can have fairly mild side effects with natalizumab when you’ve had your infusion, like headache or fatigue, but the big concern about this drug is the potential of a viral infection of the brain called progressive multifocal leukoencephalopathy or PML for short. And that’s a viral infection which becomes more of a risk after you’ve had at least two years of treatment with natalizumab. If you are known to have antibodies to the virus in your blood, so you’ll hear that referred to as being JCV positive. If you’re JCV negative, and that means that you don’t have antibodies to the virus in your blood, then your risk is really tiny of developing PML. For alemtazumab the risks are quite different actually and they’re risks of what we call auto-immune condition, so that’s when your own immune system reacts to an organ. So the common auto-immune problems with alemtuzumab treatment are with the thyroid with up to 30% of people developing problems with the thyroid – but these are treatable conditions – problems with blood clotting, so in effect on the sticky blood cells called platelets, and problems with the kidneys. When you have the infusions of alemtuzumab people also sometimes can get a high temperature, sometimes they can get racing of the heart and sometimes they can get some itching, but they’re treated with simple treatments like antihistamines and paracetamol during the infusion.
Andy: Okay, so once on one of these infusions, does treatment, the visits to the hospital and the infusions, does that process carry on indefinitely?
Dr Helen Ford: Yeah, again that varies between the drugs. So with natalizumab you need to have an infusion every four weeks, so people usually come to the hospital, usually to a day case unit, to have their infusion on a four-weekly basis. If you are negative for the JC virus, then actually your treatment can continue indefinitely. If you’re positive for the JC virus then you need to really discuss your ongoing treatment with your neurologist and discuss the risks of PML, which are changing as new cases occur. So I think it’s always good to get up to date with your neurologist and MS specialist nurse about the current data on risk.
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