Thursday, May 03, 2007

Daclizumab in multiple sclerosis

The monoclonal antibody daclizumab, which is currently used to prevent rejection in organ transplantion recipients, also shows efficacy in the treatment of multiple sclerosis (MS) patients, reported Eman Ali, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, and colleagues. Almost two-thirds of patients who received this agent in a recent clinical trial experienced an improvement or stabilization in Expanded Disability Status Scale (EDSS) scores. Daclizumab is a humanized monoclonal antibody directed against the interleukin (IL)-2 receptor a subunit that is expressed on activated T cells. According to Dr. Ali, daclizumab may be efficacious in MS because of its ability to block this receptor subunit, thereby inhibiting IL-2 signaling, limiting T-cell expansion, and reducing brain inflammation. Dr. Ali and colleagues conducted a retrospective study of this agent in 40 relapsing–remitting MS (RRMS) patients and 15 secondary–progressive MS (SPMS) patients for a mean period of 13 months, most of whom were also receiving ß-interferon treatment. The investigators found that EDSS scores improved in 20% of patients, stabilized in 40%, and worsened in 40%. Treatment effects were more favorable in RRMS patients, with about 63% showing improvement or stabilization. In SPMS patients, improvement or stabilization was seen in about 53% of patients. In a subgroup of 28 patients, the tolerability of the drug was evaluated by a 0–10 visual analogue scale (0=very well tolerated, 10=not tolerated), and the average score was shown to be 1.87. Fatigue and nausea were the most common side effects followed by skin rash.

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