Lemtrada (alemtuzumab) is a powerful medication used primarily to treat relapsing forms of multiple sclerosis (MS), especially in patients who have not responded well to other treatments. It works by targeting and depleting certain immune cells, which helps reduce the abnormal immune attack on the nervous system. However, because it profoundly affects the immune system, Lemtrada infusions carry significant risks that require careful management and monitoring.
One of the most common risks during Lemtrada infusion is an **infusion-related reaction**. These reactions can occur in up to 90% of patients receiving treatment. Symptoms may include rash, headache, fever, nausea, chills, flushing, shortness of breath or difficulty breathing (bronchospasm), swelling in the throat area that can cause airway obstruction, chest pain or tightness, changes in blood pressure (either high or low), rapid heartbeat (tachycardia), and sometimes fluid accumulation in the lungs. Because these symptoms can escalate quickly during infusion sessions that last several hours, patients are closely monitored throughout their treatment.
To reduce these infusion reactions’ severity and frequency, premedication protocols are standard practice before starting Lemtrada infusions. Patients typically receive corticosteroids intravenously about 30 minutes prior to infusion along with antihistamines and analgesics either orally or intravenously. These medications help blunt allergic-type responses and inflammation triggered by Lemtrada entering the bloodstream.
If an infusion reaction occurs despite premedication—such as sudden breathing difficulty or severe rash—the healthcare team will immediately pause or slow down the infusion rate until symptoms improve; if necessary they may stop it altogether for safety reasons.
Beyond immediate reactions during administration itself lies a broader set of **immune-related risks** due to how Lemtrada alters immune function long term:
– **Autoimmune conditions:** After treatment with Lemtrada there is a risk that new autoimmune diseases develop months or even years later because resetting parts of your immune system can cause it to mistakenly attack healthy tissues again but differently than before treatment. Common autoimmune complications include thyroid disorders like hyperthyroidism or hypothyroidism; kidney problems such as anti-glomerular basement membrane disease affecting kidney filtering; platelet destruction leading to bleeding issues; and less commonly other organ-specific autoimmune diseases.
– **Infections:** Since Lemtrada reduces certain white blood cells critical for fighting infections—especially lymphocytes—patients become more vulnerable not only while receiving infusions but also for years afterward while their immune systems rebuild slowly over time. This increased susceptibility includes bacterial infections like pneumonia as well as viral infections including herpes viruses reactivating.
– **Cancer risk:** There is some evidence suggesting a slightly elevated risk for certain cancers after using immunosuppressive therapies like Lemtrada due to impaired cancer surveillance by weakened immunity over time.
Because these serious delayed effects exist alongside acute infusion risks:
– Patients must enroll in special monitoring programs requiring regular blood tests every month for at least four years after their last dose.
– Monitoring includes checking complete blood counts looking specifically at neutrophils (a type of infection-fighting cell) plus screening thyroid function tests regularly.
– Neurological assessments continue vigilantly since rare but devastating brain infections such as progressive multifocal leukoencephalopathy (PML)—caused by JC virus reactivation—have been reported with similar immunosuppressive drugs though very rarely with Lemtrada itself.
The actual process of administering Lemtrada involves slow intravenous infusions lasting several hours per session across multiple days depending on dosing cycles prescribed by neurologists specialized in MS care.
Patients should be aware that although many tolerate this therapy well when properly managed under expert supervision:
1. Infusion reactions are common but usually manageable with premedication and close observation.
2. Serious autoimmune complications require lifelong vigilance even after stopping therapy.
3. Infection prevention strategies including vaccinations before starting therapy plus prompt evaluation if sign
