Is Lemtrada for MS Right for You?

Illustration of multiple sclerosis, which damages the myelin sheath of the axons and motoneurons
Damage to the myelin sheath caused by MS. BSIP/UIG / Getty Images

The purpose of this article about Lemtrada (alemtuzumab) is not to tell you if I think it is a good idea or not to take this drug, but to give you the facts in plain language, so that you can evaluate it for yourself and discuss it with your neurologist.

When I was trying to choose my treatment, I know that it was hard to find information about these drugs that was from a neutral source.

Having set my goal as giving you the information that I was interested in when I was trying to make a decision about my disease-modifying therapy, I will start with my Bottom Line, summarizing my take on Lemtrada.

I have more detailed information, which follows.

Bottom Line

After carefully reviewing the information about Lemtrada, I have to say, Lemtrada is a little intimidating in terms of side effects. I am sensitive to pretty much any drug, including rather benign antibiotics, so I know that I would probably be affected by many of the unpleasant side effects listed in the package insert. In terms of the more serious side effects, those would also cause me some concern, especially the fact that over a third of people taking Lemtrada develop thyroid dysfunction, not to mention some of the more serious side effects. I maintain that fear of possible side effects and the anxiety that this causes can be, in itself, a serious side effect of certain treatments. Monitor Side Effects of MS Medications. Also, I am a little turned off by the idea of five years of monthly blood tests - not so much for the jabs but just for the inconvenience of it.

However, I don't know how I would feel if I had already failed to respond to two other MS disease-modifying medications and noticed my disability progressing rapidly. Honestly, as time goes by and there are an increasing number of therapies for MS available (beyond just the CRAB drugs, which are all pretty much the same safety profile and effectiveness), I am less able to say which one I would choose.

One thing that I will encourage all people to do, regardless of which therapy that are considering, is to do extensive research on the medications. Some ideas on how to do some structured investigation are outlined in my article, Research Your Treatment Options. I've tried to provide some relevant details below, but there is always much more to be learned once you start digging.

More Detailed Information on Lemtrada

Type of MS and Severity

Lemtrada is for relapsing-remitting MS. However, it is not prescribed as a “first-line” medication (the first disease-modifying medication that would be tried). In fact, the manufacturer specifies: “Because of its safety profile, the use of LEMTRADA should generally be reserved for patients who have had an inadequate response to two or more drugs indicated for the treatment of MS.”


Two phase III clinical trials showed that, compared to Rebif, Lemtrada can significantly reduce relapse rates.

The CARE-MS 1 trial compared Lemtrada with Rebif in people with RRMS who were treatment naïve (meaning that they had never taken any disease-modifying therapy) and found that those people taking Lemtrada were around 55 percent less likely to experience a relapse over the course of two years.

The CARE-MS 2 trial compared Lemtrada with Rebif in people with RRMS who had experienced at least one relapse while they were taking Rebif or Copaxone. The people in the Lemtrada arm were around 50 percent less likely to experience a relapse and 42 percent less likely to experience disability progression over the course of two years than those in the Rebif arm.

A longer-term follow-up study was conducted on people who participated in the clinical trials and the data showed that the majority of people who took Lemtrada experienced an overall improvement in disability (or stayed stable) over seven years.

Necessary Monitoring

Because of potentially dangerous, even fatal, side effects, people on Lemtrada are screened very carefully and monitored for many things for a total of five years (the year of treatment and for four years following the last infusion). See Lemtrada Monitoring

Injection/Administration Considerations

Lemtrada is given as an intravenous (IV) infusion on five consecutive days. Then, 12 months later, there is a second course on three consecutive days. So far, that is it – for most patients in the clinical trials, no further treatment has been required.

So, while people who really hate needles may be very excited to hear that the administration of Lemtrada is relatively “light” in the needle department, anyone on Lemtrada needs to follow a pretty intense monitoring program, requiring blood tests (read: needles) monthly for 48 months after the last infusion.

Side Effects of Lemtrada

Lemtrada has several potential side effects, many of them simply annoying and uncomfortable, but some are much more serious and even life-threatening. The most common side effects include headaches, rash, nausea, fatigue, insomnia, hives, fever, itching. Many people also report chest infections, urinary tract infections, cold sores and sinusitis.

The more serious side effects reported with Lemtrada include:

  • Thyroid dysfunction, or the development of an overactive or underactive thyroid
  • Immune thrombocytopenia (ITP), a blood clotting disorder
  • Serious infusion associated reactions (IARs)
  • Development of malignancies or cancer

It should be noted that, although not mentioned in the clinical trial data or package inserts, some of these side effects can last long after the infusions are over. In fact, patients report the fatigue, insomnia and stomach problems lasting for months following the infusions. I found the following account that was written by a person receiving the recommended two courses extremely interesting, in terms of effects of Lemtrada (both side effects and effects on MS): David’s Campath Story


Lemtrada received FDA approval as an MS therapy in November 2014. Originally, Lemtrada (under the brand name Campath) was approved for use in much higher doses to treat B-cell chronic lymphocytic leukemia.

Ease of Use

Again, this drug is administered as an infusion in a hospital or clinic, so the patient never administers it at home.


Lemtrada is contraindicated in (should not be taken by) people:

  • with HIV infection
  • who have tuberculosis (active or latent)
  • who have severe active infections
  • who have cancer
  • who are taking chemotherapy or are on immunosuppressive drugs
  • with a history of progressive multifocal leukoencephalopathy (PML)


Lemtrada is rated as a Pregnancy Category C. This means that there have been no adequate studies in pregnant women, but based on animal studies, Lemtrada may cause harm to the fetus. If you become pregnant after treatment with Lemtrada and experience thyroid problems during pregnancy, extra caution is needed. Thyroid problems could be harmful to the baby.

It is recommended that women use effective forms of contraception during treatment and for at least four months following a course of treatment with Lemtrada, so they do not become pregnant. Same with breastfeeding – it is recommended that women do not breastfeed while using Lemtrada, as it could be transferred to the baby via breast milk.


Lemtrada costs $158,000 for the entire two-course duration of treatment. While other MS drugs come in at less for the same period of time (12 months), it is difficult to compare costs, as Lemtrada currently only requires the two courses of treatment in a lifetime, whereas other drugs are taken for the rest of a person’s life, or until they are no longer effective or there is another indication to switch to another medication.