Alemtuzumab-induced thyroid disease: A Danish cohort study

Area of Science:

• Immunology
• Endocrinology
• Neurology

Background:

• Alemtuzumab, a CD52-targeting monoclonal antibody, is a treatment for multiple sclerosis (MS).
• A known side effect of alemtuzumab therapy is the development of secondary autoimmune thyroid disease.
• Understanding the incidence and characteristics of these thyroid conditions is crucial for patient management.

Purpose of the Study:

• To determine the rate, type, and clinical course of thyroid disease in Danish MS patients treated with alemtuzumab.
• To characterize the specific thyroid conditions that arise secondary to alemtuzumab therapy.
• To provide insights into the long-term management of alemtuzumab-induced thyroid disorders.

Main Methods:

• Retrospective cohort study involving 60 MS patients treated with alemtuzumab in Denmark (2014-2018).
• Follow-up duration was a median of 81 months.
• Analysis included the types of thyroid disease, their presentation, and treatment outcomes.

Main Results:

• Thyroid disease developed in 47% of patients.
• Graves' disease (GD), often TSH receptor antibody (TRAb) positive, was most common (35%), followed by multinodular goitre (5%) and thyroiditis (7%).
• 67% of GD cases exhibited unusual, fluctuating courses, often requiring complex management including antithyroid drugs, thyroxine, block-and-replace therapy, or thyroidectomy.

Conclusions:

• Alemtuzumab-induced Graves' disease in MS patients can follow unpredictable and prolonged courses.
• Long-term, frequent biochemical monitoring is recommended for these patients.
• Consideration of combined block-and-replace therapy or thyroidectomy may be necessary for specific patient subgroups.