Cost-Benefit Analysis

Title: Cancer Drug Shows Promise Against MS, But With Some Risks
Author: Rita Rubin

Summary:

In a recent study, the leukemia drug, alemtuzumab, has proven effective in treating a remarkable amount of multiple sclerosis (MS) patients when compared to others treated with an alternate drug, Rebif. MS is a disease where a person’s immune system breaks down the myelin sheath of nerve cells, which slows neural impulse conduction and causes neurologic dysfunction. Alemtuzumab is known as a monoclonal antibody, derived from a single cell in large quantities for use against a specific protein of disease. Specifically, alemtuzumab will destroy the certain white blood cells of the immune system that attack the myelin sheaths and replace them with ones that don’t.

History and Progression:
Alemtuzumab was originally intended to treat chronic lymphocytic leukemia, but has been effective in pre-operative conditioning for bone marrow or kidney transplants. The drug is known to significantly increase the risk for opportunistic infections, as it lowers the immunity threshold.

There are several different types of MS, though this study concentrates on the relapsing-remitting subtype. This can demonstrate symptoms of neurological deficit followed by an undeterminable amount of time with no signs of disease activity. Deficits include changes in sensation, muscle weakness or myoclonus, dyskinesia, ataxia, dysarthria, dysphagia, nystagmus, diplopia, fatigue, and pain, among other motor and cognitive symptoms. While there are various treatment options, Rebif is delivered by injection to reduce the frequency of occurrences and hopefully slow the disease progression towards permanent disability.

The aforementioned trial involved 334 MS patients and their assignment of a random treatment regimen involving either annual alemtuzumab injections or tri-weekly Rebif injections over the course of three years. The double-blind study proved alemtuzumab to be 70% more effective than Rebif, despite the discovered side effects of increased risk of thyroid or platelet autoimmune malady. It is expected that, if under close monitoring, MS patients would see significant results while using alemtuzumab.

Safety:
According to the article, it is uncertain how alemtuzumab increases the risk for autoimmune complications and apparently one trial participant died as a result. Further studies on pharmacokinetics and pharmacodynamics, as well as closer monitoring of patients, need to be done before widespread distribution of this treatment is begun.

Quality:
Provided a safe regimen is developed, alemtuzumab has the potential to dramatically increase the quality of life for many recently-diagnosed relapsing-remitting MS patients. Hopefully its use would consistently prevent exacerbations and delay the onset of permanent effects. Additionally, it could possibly open doors to further MS understanding and treatment and eventually a cure and/or prevention.

Effectiveness:
It seems that the risks currently outweigh the benefits. Lowered thyroid and/or platelet autoimmunity could lead to much more serious systemic problems. Combined with the various MS symptoms and other potential medical issues, this drug’s use could be very dangerous and much riskier than other available treatments.

Positive Benefits:
The reduced MS symptoms and delayed disability resulting from proper use of alemtuzumab.

Negative Effects:
Potential autoimmune deficits, other complications, or death can be attributed to non-compliance or other unforeseen problems.

Political Beliefs:
I’m not sure how much this treatment would cost a person or insurance company. Perhaps only the fortunate could afford such a drug, which would limit potential quality of life gains to the rich. I believe that all treatments should be made available, by some vehicle, to those that require it.

Religious Beliefs:
It’s possible that some people believe that pharmaceuticals or other scientific interventions are inappropriate and that people should not interfere with what their god has planned for MS sufferers. I believe that we should take all the scientific advantages that we have available to us.