Alemtuzumab-induced lung injury in multiple sclerosis: Learning from adversity in three patients

Alemtuzumab in multiple sclerosis during the COVID-19 pandemic: A mild uncomplicated infection despite intense immunosuppression

“…Alemtuzumab causes the depletion of CD52-expressing cells, leading to a transient alteration in lymphocyte numbers, trafficking and function after each course, and thus to an increased risk of infection, 2,3 including both upper (very common; ⩾10%) and lower respiratory tract infections (common; 1%–10%). 4 The risk of COVID-19 in alemtuzumab-treated MS patients is unknown, but a higher risk is conceivable. For these reasons, Brownlee et al 2 recently recommended that alemtuzumab should not be initiated in MS patients who are about to start a treatment, and, for those already on treatment, to delay further courses, considering the risks and benefits.…”

Alemtuzumab-associated diffuse alveolar damage – a case report

“…Over the last years, reports of serious adverse events also affecting the lungs have prompted the EMA to amend the label for alemtuzumab [ 7 ]. More recently, further cases of treatment-induced lung injury have broadened the spectrum of non-infective respiratory disorders after alemtuzumab treatment in MS [ 5 ]. To our knowledge, our case is the first report of DAD in MS after alemtuzumab treatment examined histologically.…”

“…To our knowledge, our case is the first report of DAD in MS after alemtuzumab treatment examined histologically. ARDS as a clinical correlate of DAD after alemtuzumab treatment in MS has recently been published, but lung biopsy is not reported [ 5 ]. DAD is characterized by dyspnea and dry cough progressing over a period of days or weeks.…”

“…Well-known side effects include an increased infection rate including respiratory tract infections and secondary autoimmune reactions mainly consisting of thyroid disorders, immune thrombocytopenia, anti-glomerular basement membrane (GBM) disease and membranous glomerulonephritis, which may occur after years of first treatment. Since its approval by the European Medicines Agency (EMA) in 2013, non-infective respiratory tract side effects causing dyspnea have been reported in patients treated with alemtuzumab including diffuse alveolar hemorrhage [ 2 ], pneumonitis [ 3 ], anti-GBM antibody disease [ 4 ] and acute respiratory distress syndrome (ARDS) [ 5 ]. Five cases of diffuse alveolar damage (DAD) associated with alemtuzumab have been reported to VigiBase©, the World Health Organization’s international database for suspected adverse drug reactions [ 6 ], without providing further details on treated disorders or other potentially confounding factors.…”

“…Our report describes a patient with DAD after alemtuzumab treatment for MS. Compared to cases of alemtuzumab associated DAD published so far [ 6 ], here we present detailed clinical data and results of apparative diagnostics, furthermore histological findings that have so far not been reported in ARDS associated with alemtuzumab treatment [ 5 ].…”