Alemtuzumab-induced thyroid events in multiple sclerosis: a systematic review and meta-analysis

Area of Science:

• Neurology
• Endocrinology
• Immunology

Background:

• Autoimmune thyroid events (ATEs) are recognized side effects of alemtuzumab (ALZ) therapy.
• Alemtuzumab is used in the treatment of multiple sclerosis (MS).
• Understanding the prevalence and outcomes of ALZ-induced ATEs is crucial for patient management.

Purpose of the Study:

• To provide robust evidence on the prevalence and outcomes of the spectrum of alemtuzumab-induced autoimmune thyroid events in multiple sclerosis patients.
• To synthesize existing data on alemtuzumab-associated thyroid dysfunction.

Main Methods:

• Systematic literature search of PubMed and Scopus up to July 2019.
• Inclusion of studies on MS patients treated with alemtuzumab without prior thyroid disease.
• Meta-analysis using a random-effects model to pool data on ATE prevalence and outcomes.

Main Results:

• A 33% prevalence of newly diagnosed ATEs was observed in 1362 MS patients treated with alemtuzumab.
• Graves' disease (GD) was the most frequent ATE (63%), followed by Hashimoto thyroiditis (15%).
• Graves' disease exhibited a fluctuating course in 15% of cases, with varying treatment responses including spontaneous remission, antithyroid drugs, radioactive iodine, and surgery.

Conclusions:

• Graves' hyperthyroidism is the predominant alemtuzumab-induced autoimmune thyroid event.
• Antithyroid drugs are recommended as the first-line treatment for alemtuzumab-induced Graves' disease.
• Alemtuzumab-induced Graves' disease may have a fluctuating and unpredictable course, similar to conventional GD.