A real-life study of alemtuzumab in persons with multiple sclerosis: Kuwait's experience

Alroughani, Raed; AlMojel, Malak; Al-Hashel, Jasem; Ahmed, Samar Farouk

doi:10.1016/j.msard.2023.104712

Cited by 3 publications

(3 citation statements)

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“…Through the database search, a total of 3530 articles were initially identified. After the preliminary screening and subsequent full-text assessment, a final selection of 37 studies was included in the analysis ( Table 1 , Figure 1 ) ( 12 – 48 ). All of the included studies were written in English, with 26 studies were published in 2020 or later.…”

Section: Resultsmentioning

confidence: 99%

Risk of secondary autoimmune diseases with alemtuzumab treatment for multiple sclerosis: a systematic review and meta-analysis

Yang,

Sun,

Zhou

et al. 2024

Front. Immunol.

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Background and purposeThe objective of this study is to evaluate the risk of secondary autoimmune diseases in multiple sclerosis (MS) patients treated with alemtuzumab (ALZ) through a meta-analysis.MethodsPubMed, Web of Science, OVID, EMBASE, and Cochrane central register of controlled trials were searched. Information and data were screened and extracted by 2 researchers. The obtained data were analyzed using the R software meta package. Quality assessment was conducted using the Newcastle-Ottawa Scale (NOS). The causes of heterogeneity were analyzed using subgroup analysis and sensitivity analysis. Publication bias was evaluated using funnel plots and Egger’s test.ResultsThe search retrieved a total of 3530 papers from the databases. After screening, a total of 37 studies were included in the meta-analysis. The analysis results indicate that the pooled incidence rate of overall secondary autoimmune events (SAEs) in the included studies was 0.2824 [0.2348, 0.3300] (I²=94%, p<0.01). The overall incidence of autoimmune thyroid events (ATE) was 0.2257 [0.1810, 0.2703] (I²=94%, p<0.01). Among them, the rate of serious autoimmune thyroid events (SATE) was 0.0541 [0.0396, 0.0687] (I²=0%, p=0.44). The incidence rates of different thyroid events were as follows: Graves’ disease (GD), 0.2266 [0.1632, 0.2900] (I²=83%, p<0.01); Hashimoto thyroiditis (HT), 0.0844 [0.0000, 0.2262] (I²=81%, p=0.02); Hashimoto thyroiditis with hypothyroidism (HTwH), 0.0499 [0.0058, 0.0940] (I²=37%, p=0.21); fluctuating thyroid dysfunction (FTD), 0.0219 [0.0015, 0.0424] (I²=0%, p=0.40); transient thyroiditis (TT), 0.0178 [0.0062, 0.0295] (I²=0%, p=0.94). The overall incidence of hematological events was 0.0431 [0.0274, 0.0621] (I²=70%, p<0.01). The incidence rates from high to low were as follows: lymphopenia, 0.0367 [0.0000, 0.0776] (I²=81%, p=0.02); Idiopathic thrombocytopenic purpura (ITP), 0.0258 [0.0199, 0.0323] (I²=25%, p=0.15); Hemolytic anemia (HA), 0.0177 [0.0081, 0.0391] (I²=29%, p=0.23); pancytopenia, 0.0136 [0.0000, 0.0314] (I²=0%, p=0.67); Neutropenia, 0.0081 [0.0000, 0.0183] (I²=0%, p=0.42). After excluding thyroid and hematological diseases, the combined incidence of other related SAEs was 0.0061 [0.0014, 0.0109] (I²=50%, p=0.02). The incidence of each disease ranked from highest to lowest as: skin psoriasis (SP), 0.0430 [0.0000, 0.0929] (I²=0%, p=0.57); alopecia areata (AA), 0.0159 [0.0024, 0.0372] (I²=19%, p=0.29); vitiligo, 0.0134 [0.0044, 0.0223] (I²=0%, p=0.81); inflammatory atrichia (IA), 0.0103 [0.0000, 0.0232] (I²=0%, p=0.43); chronic urticaria (CU), 0.0107 [0.0000, 0.0233] (I²=0%, p=0.60); and nephropathy, 0.0051 [0.0000, 0.0263] (I²=62%, p=0.02).ConclusionThe occurrence of secondary autoimmune diseases in patients with MS treated with ALZ is noteworthy, particularly in the form of thyroid events and hematological events. Clinicians should monitor the overall condition of patients promptly for early management and avoid delayed diagnosis and treatment.Systematic review registrationinplasy.com/inplasy-2024-4-0048/, identifier INPLASY202440048.

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Section: Resultsmentioning

confidence: 99%

Risk of secondary autoimmune diseases with alemtuzumab treatment for multiple sclerosis: a systematic review and meta-analysis

Yang,

Sun,

Zhou

et al. 2024

Front. Immunol.

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“…These studies encompass a total of 2605 individuals, primarily from multicenter studies. 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 The number of patients reported ranged from 19 to 883. The follow‐up duration in most of these studies covered 2 to 3 years of observation after ALEM start.…”

Section: Resultsmentioning

confidence: 99%

“…PIRA was defined as an increase of ≥0.5 points on the EDSS scale, persisting over 6 months and without evidence of relapses within the range of ±30 days). 3 , 21 If relapses with incomplete recovery occurred during the observation period, the reference EDSS was reset ≥90 days after the relapse onset for PIRA‐event assessment. We defined CDI as a 6‐month confirmed improvement of ≥0.5 points on the EDSS.…”

Section: Methodsmentioning

confidence: 99%

Alemtuzumab treatment for multiple sclerosis in Austria: An observational long‐term outcome study

Moser,

Foettinger,

Hitzl

et al. 2024

Ann Clin Transl Neurol

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Background/ObjectiveObservational real‐world study to analyze the clinical effects of alemtuzumab (ALEM) and subsequent disease‐modifying therapy (DMT) usage in multiple sclerosis (MS).MethodsData retrieved from the Austrian MS treatment registry (AMSTR) included baseline (BL) characteristics (at ALEM start), annualized relapse rate (ARR), 6‐month confirmed progression independent of relapse activity (PIRA; ≥ 0.5‐point Expanded Disability Status Scale (EDSS) score increase), 6‐month confirmed disability improvement (CDI; ≥ 0.5‐point EDSS decrease), and safety outcomes until initiation of a subsequent DMT. The EDSS was re‐baselined at 30 days from ALEM start (BL EDSS).ResultsEighty‐seven ALEM‐treated patients (median age: 32 years, 72% female, 14% treatment‐naïve) were followed for a median of 55 (interquartile range 31–68) months. We found significant reductions in the ARR from 1.16 before ALEM to 0.15 throughout Years 1–9 (p < 0.001). Subsequent DMTs were initiated in 19 patients (22%, 74% anti‐CD20 monoclonal antibodies). At Year 5 (n = 53), more patients achieved CDI (58%, 95% confidence interval (CI) 45%–71%) than had experienced PIRA (14%, CI 7.5%–24%), and 58% remained relapse‐free. Shorter MS duration (p < 0.001, hazard ratio (HR) 0.86 (CI 0.80–0.93)) and no previous high‐efficacy treatment (p < 0.001, HR 5.16 (CI 2.66–10.0)) were the best predictors of CDI, while PIRA was associated with a higher number of previous DMTs (p = 0.04, HR 3.06, CI 1.05–8.89). We found no new safety signals.InterpretationALEM had long‐lasting beneficial effects on the ARR and disability improvement, especially when initiated early in the course of the disease. Only a subset of patients received subsequent DMTs.

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A real-life study of alemtuzumab in persons with multiple sclerosis: Kuwait's experience

Cited by 3 publications

References 42 publications

Risk of secondary autoimmune diseases with alemtuzumab treatment for multiple sclerosis: a systematic review and meta-analysis

Risk of secondary autoimmune diseases with alemtuzumab treatment for multiple sclerosis: a systematic review and meta-analysis

Alemtuzumab treatment for multiple sclerosis in Austria: An observational long‐term outcome study

Alemtuzumab

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