Treatment with alemtuzumab or rituximab after fingolimod withdrawal in relapsing–remitting multiple sclerosis is effective and safe

  • Carmen AlcaláEmail author
  • F. Gascón
  • Francisco Pérez-Miralles
  • J. A. Domínguez
  • S. Gil-Perotín
  • B. Casanova
Original Communication



It has been described that treating relapsing–remitting multiple sclerosis (RRMS) patients with alemtuzumab following fingolimod could be less effective due to the different dynamics of lymphocyte repopulation. Effectiveness and safety of alemtuzumab compared to rituximab after fingolimod withdrawal were analyzed.

Patients and methods

A follow-up of a cohort of RRMS patients treated with alemtuzumab or rituximab after fingolimod withdrawal was accomplished. Effectiveness, measured by the percentage of patients with no evidence of disease activity (NEDA), and the presence of side effects (SE) were registered.


Fifty-five patients, 28 with alemtuzumab and 27 with rituximab, were analyzed. No differences in the washout period or in the baseline lymphocytes counts were observed. After a mean follow-up period of 28.8 months, the annualized relapsing rate was significantly reduced in the alemtuzumab group from 1.29 to 0.004 (p < 0.001) and in the rituximab group from 1.24 to 0.02 (p < 0.001), without differences. A significant reduction of the median EDSS from 2.8 to 2.0 in the alemtuzumab group and from 3.5 to 2.5 (p < 0.01) in the rituximab group was observed, without differences. Eighty-two per cent (n = 28) of patients in alemtuzumab group and 69.2% (n = 26) in rituximab group achieved NEDA criteria, without differences (p = 0.3). Symptoms related to the infusion were the most frequent SE in both groups. No serious SE were registered.


Treating RRMS patients with alemtuzumab or rituximab after fingolimod withdrawal is effective and safe, without significant differences between both groups in our series.


Relapsing–remitting multiple sclerosis Treatment Alemtuzumab Rituximab Fingolimod withdrawal Lymphocyte repopulation 


Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical standard

All patients included in the study acceded to donate and signed a specific informed consent and all research was conducted following legal and ethical requirements at the Research Institute of the Hospital La Fe and was approved by its Institutional Review Board.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurologyLa Fe HospitalValenciaSpain
  2. 2.Department of NeurologyClinic HospitalValenciaSpain

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