Alemtuzumab Induced Thyroid Disease in Multiple Sclerosis: A Review and Approach to Management

Mahzari, Moeber; Arnaout, Amel; Freedman, Mark S.

doi:10.1017/cjn.2015.48

Cited by 15 publications

(17 citation statements)

References 31 publications

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“…Importantly, several data suggest that long-term interferon beta therapy, a widespread therapy for MS, could induce thyroid autoimmunity and potentially lead to overt thyroid disease [184,185]. Apart from interferon treatments, alemtuzumab is known for its thyroidal side effects [119]. Therefore, an initial evaluation of thyroid-stimulating hormone (TSH) and the presence of ATA antibodies would help in guiding the management strategy.…”

Section: Endocrine Diseasesmentioning

confidence: 99%

Fatigue in multiple sclerosis – Insights into evaluation and management

Ayache

Chalah

2017

Neurophysiologie Clinique/Clinical Neurophysiology

126

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Section: Endocrine Diseasesmentioning

confidence: 99%

Fatigue in multiple sclerosis – Insights into evaluation and management

Ayache

Chalah

2017

Neurophysiologie Clinique/Clinical Neurophysiology

126

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“…Thyroid dysfunction is the most commonly reported autoimmune AE in alemtuzumab-treated patients, with the thyroid gland being adversely affected in ~36% of patients in a 4-year follow-up of the CARE-MS I and II trials [94]. Autoimmune thyroid disease may lead to hyperthyroidism (increased thyroid hormone levels in the serum with suppressed thyroid-stimulating hormone) or hypothyroidism and neurologists need to be aware of how to diagnose and treat these conditions [94].…”

Section: Risk Minimization and Patient Monitoringmentioning

confidence: 99%

“…Autoimmune thyroid disease may lead to hyperthyroidism (increased thyroid hormone levels in the serum with suppressed thyroid-stimulating hormone) or hypothyroidism and neurologists need to be aware of how to diagnose and treat these conditions [94]. Typically, changes in thyroid-stimulating hormone, thyroxine, and tri-iodothyronine levels are evaluated [95, 96].…”

Section: Risk Minimization and Patient Monitoringmentioning

confidence: 99%

“…In some centers, thyroid antibodies are also investigated and where hyper- or hypothyroidism is suspected these cases are followed up with an ultrasound examination of the thyroid gland. A recent article by Mahzari et al presents case studies for four patients from the CARE-MS trials who developed autoimmune thyroid disease and provides a comprehensive account of the signs and symptoms to be aware of [94]. …”

Section: Risk Minimization and Patient Monitoringmentioning

confidence: 99%

“…Anti-thyroid medications are not applicable in these patients as thyroid hormone synthesis is already low. An algorithm for the treatment of patients presenting with alemtuzumab-induced hyperthyroidism has been proposed by Mahzari et al [94]. …”

Section: Risk Minimization and Patient Monitoringmentioning

confidence: 99%

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Alemtuzumab Use in Clinical Practice: Recommendations from European Multiple Sclerosis Experts

et al. 2016

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Alemtuzumab (Lemtrada™) is a humanized monoclonal antibody approved in more than 50 countries. Within the European Union, alemtuzumab is indicated for the treatment of adult patients with relapsing-remitting multiple sclerosis (RRMS) with active disease defined by clinical or imaging features; in the USA, the indication states that alemtuzumab should generally be reserved for the treatment of patients with relapsing forms of multiple sclerosis who have had an inadequate response to two or more disease-modifying therapies (DMTs). In clinical trials, alemtuzumab demonstrated efficacy in treatment-naïve patients with active RRMS and those relapsing on prior DMTs, with a consistent and manageable safety and tolerability profile. The European Union indication provides physicians with significant flexibility regarding treatment decisions, affording the opportunity for individualized treatment. Thus, alemtuzumab may be an appropriate treatment choice across a broad range of patients with RRMS, including, for example, treatment-naïve patients with active disease, patients with highly active disease, or for patients relapsing on prior DMTs. There are several practicalities to consider when using alemtuzumab, including the unique dosing regimen, administered via intravenous infusion on 5 consecutive days at baseline and on 3 consecutive days 12 months later, and as-needed retreatment (3 consecutive days at least 12 months after the last course) in cases of disease recurrence. Additionally, routine monthly monitoring is required for up to 48 months after the last infusion to promptly identify potentially serious autoimmune adverse events. Given these considerations, it is beneficial to gain insight into how alemtuzumab is being used in the real-world clinical setting. Here, we report recommendations from European multiple sclerosis experts regarding best practices for alemtuzumab treatment, including management of adverse events and compliance with ongoing safety monitoring requirements.

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Monitoring and management of autoimmunity in multiple sclerosis patients treated with alemtuzumab: practical recommendations

Devonshire

Phillips

Wass³

et al. 2018

J Neurol

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Alemtuzumab is a humanized anti-CD52 monoclonal antibody approved in more than 65 countries for the treatment of relapsing–remitting multiple sclerosis (RRMS). Compared with subcutaneous interferon-beta-1a, alemtuzumab significantly reduced clinical disease activity and the rate of brain volume loss, and improved disability outcomes in patients with active RRMS who were either treatment naive (CARE-MS I study) or who had an inadequate response (≥ 1 relapse after ≥ 6 months of treatment) to prior therapy (CARE-MS II study). Adverse events (AEs) associated with alemtuzumab include infusion-associated reactions, infections, and autoimmunity. The most commonly reported autoimmune AEs observed with alemtuzumab involve the thyroid gland, followed by immune thrombocytopenia and nephropathies. A monitoring program was designed and implemented to facilitate the early detection of autoimmune events to ensure timely and adequate management. The aim of this article is to provide physicians (including neurologists, general practitioners, endocrinologists, hematologists, and nephrologists who may be less familiar with the symptoms and treatment of autoimmune events), with practical real-world recommendations for the monitoring and management of autoimmunity associated with alemtuzumab treatment.

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Alemtuzumab Induced Thyroid Disease in Multiple Sclerosis: A Review and Approach to Management

Cited by 15 publications

References 31 publications

Fatigue in multiple sclerosis – Insights into evaluation and management

Fatigue in multiple sclerosis – Insights into evaluation and management

Alemtuzumab Use in Clinical Practice: Recommendations from European Multiple Sclerosis Experts

Monitoring and management of autoimmunity in multiple sclerosis patients treated with alemtuzumab: practical recommendations

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