Alemtuzumab and multiple sclerosis

The treatment of multiple sclerosis (MS) is complex. In the United States, we have 8 different classes of drugs approved for treating relapsing-remitting MS (RRMS).1 The first-generation therapies, glatiramer acetate and the β-interferons, have an impressive 20-year record of safety and many patients with RRMS have their disease well-controlled by these agents. Newer treatments, such as natalizumab, fingolimod, and dimethyl fumarate, may be more efficacious and convenient than the first-generation therapies. However, they lack a long-term safety record and some, such as natalizumab, have proved to be riskier than the first-generation therapies. In assessing any new therapy for RRMS, we must assess not just its efficacy but also its safety. Increased efficacy that comes with excessive risks is a Faustian bargain we should refuse.