181 Multiple Sclerosis associated with Psoriasis – is alemtuzumab the drug of choice?

Introduction Treatment of relapsing remitting (RRMS) may become challenging in the presence of other autoimmune disorders,. The risk of exacerbating coexisting systemic autoimmune illnesses often restricts the choice of DMT, particularly monoclonal antibodies. Psoraisis and MS are both relatively common conditions and may co-exist posing such a problem Case 1: 39 year old woman with poorly controlled psoriasis on methotrexate was diagnosed with highly active RRMS. Alemtuzumab led to rapid (within 5 days) and sustained (x months) remission of both MS and Psoriasis. Methotrexate was stopped prior to alemtuzumab. Case 2: A 34 year old man with severe chronic plaque psoriasis was diagnosed with highly active RRMS. Alemtuzumab led to a dramatic remission within days of his psoriatic skin lesions and MS. However after 3 months psoriasis recurred. Conclusion The remarkable response of psoriasis in these cases may be reassuring to clinicians wishing to use alemtuzumab in such situations. Though the underlying biology of the response in psoriasis is not well understood, it is primarily mediated by T Cells which Alemtuzumab effectively depletes.