Effect of 1-year treatment with interferon-beta1b on thyroid function and autoimmunity in patients with multiple sclerosis

Abstract

Objective: Interferon-b (IFN-b) is a widely used therapy for multiple sclerosis (MS), a demyelinating disease of the central nervous system. This study has evaluated the effect on thyroid function and autoimmunity of a 1-year treatment with IFN-b1b in patients with MS. Patients: We studied 31 patients (age 34 Ϯ 7 years, 21 women) with relapsing-remitting MS during IFN-b1b treatment of 1 year duration. Systematic thyroid assessment and measurements of serum interleukin-6 (IL-6) levels were performed at baseline and every 3 months during treatment.Results: Sixteen percent of the patients had autoimmune thyroiditis before IFN-b1b, all positive for anti-peroxidase antibodies. The overall incidence of thyroid dysfunction was 33% over 1 year (10% hyperthyroidism, 23% hypothyroidism). Thyroid autoimmunity developed in 5/26 patients (19%), in one case without dysfunction. In addition to autoantibody positivity at baseline, female gender and the presence of an ultrasound thyroid pattern suggestive of thyroiditis were identified by multiple logistic regression as additional risk predictors for the development of thyroid dysfunction. During IFN-b1b treatment, serum IL-6 levels rose in a consistent biphasic pattern; there was, however, no difference between patients with or without incident thyroid abnormalities. Conclusions: We conclude that IFN-b1b therapy can induce multiple alterations in thyroid function, some of which are unrelated to thyroid autoimmunity. IL-6 measurement is not useful to identify patients prone to develop thyroid abnormalities. Though thyroid dysfunction is generally subclinical and often transient, systematic thyroid assessment should be performed during IFN-b1b treatment.

The window of therapeutic opportunity in multiple sclerosis

“…Thyroid autoimmunity following the treatment of multiple sclerosis is not confined to the use of Campath-1H. Some [18,49,56], but not all [18,64] authors report a significant increase in anti-thyroid microsomal antibodies after starting IFN-β. There is one case report of Graves' disease after treatment with glatiramer acetate [27].…”

Exacerbation of Chronic Inflammatory Demyelinating Polyradiculoneuropathy during Interferon.BETA.-1b Therapy in a Patient with Childhood-onset Multiple Sclerosis

“…IFN thus appeared to trigger organ-specific autoimmune diseases in our patient. Exacerbation of autoimmune phenomena has been frequently reported with IFN (12)(13)(14)(15) but not for IFN (16), but both share a common receptor. Dayal et al (17) reported that IFN-secreting cells increased in the early course of IFN therapy.…”

Campath-1H Treatment of Multiple Sclerosis

“…Thyroid autoimmunity is not confined to treatment with Campath-1H. A number of authors [26][27][28] , but not all [29] , report a significant increase in anti-thyroid microsomal antibodies after starting interferon-␤ . There is also 1 case report of Graves' disease following treatment with glatiramer acetate [30] .…”