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Alemtuzumab-Induced Thyroid Dysfunction Exhibits Distinctive Clinical and Immunological Features
Nadia Pariani1, Mark Willis2, Ilaria Muller3
1University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, United Kingdom.
The Journal of Clinical Endocrinology and Metabolism
|June 8, 2018
Summary
Alemtuzumab treatment for multiple sclerosis (MS) frequently causes Graves disease (GD), often requiring long-term treatment. This study found a high incidence of GD and fluctuating thyroid status in MS patients, challenging previous assumptions about its indolent course.
Area of Science:
- Endocrinology
- Neurology
- Immunology
Background:
- Alemtuzumab is an effective multiple sclerosis (MS) treatment.
- It is known to predispose patients to Graves disease (GD).
- The course of GD following alemtuzumab treatment is not well-characterized.
Purpose of the Study:
- To determine the frequency and course of thyroid dysfunction (TD) in UK patients with MS treated with alemtuzumab.
- To characterize the types of TD observed.
Main Methods:
- Retrospective review of case records of alemtuzumab-treated MS patients who developed TD.
- Analysis of TD type, onset, and treatment outcomes.
Main Results:
- 41.1% of patients developed TD, primarily GD (71.6%).
- Median onset was 17 months post-treatment, with most cases within 3 years.
- A significant proportion of GD patients required definitive or long-term treatment, and fluctuating thyroid status was observed.
Conclusions:
- Graves disease after alemtuzumab is frequent and often requires prolonged treatment, contrary to previous reports.
- Fluctuating thyroid status and TRAb-positive hypothyroidism suggest dynamic antibody activity.
- Both stimulating and blocking TSH receptor antibodies (TRAb) were identified in patients.
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