Skin Autoimmunity Secondary to Alemtuzumab in a Tertiary Care Spanish Hospital

Abstract

Background and Objective:The most common adverse events following Alemtuzumab include adverse infusion reactions, infections and autoimmune disorders. Skin adverse events are common during infusion but there are few reported cases of long-term skin autoimmune disease.Methods:A retrospective case series of patients developing long-term autoimmune skin disorders following alemtuzumab administration in a tertiary care hospital.Results:Of 133 patients treated with alemtuzumab, eight patients (6.02%) developed nine autoimmune cutaneous adverse events, including four events of alopecia areata, two of vitiligo, two of chronic urticaria and one of inflammatory atrichia. Three of them occurred between the first and the second infusion.Discussion:The lesions described are secondary to autoimmune disorders, probably related to immune dysregulation due to a differential lymphocyte repopulation following alemtuzumab. Autoimmune cutaneous adverse events may be frequent, and it would be recommended to monitor its appearance in order to treat them.

Alemtuzumab-Induced Secondary Autoimmune Skin Disorders as Side Effects of Multiple Sclerosis Therapy: Problem That Can Be Influenced or Fate? A Narrative Overview of The Literature A Neuroprotective Role of Vitamin D?

“…IL-17 was significantly higher in vitiligo patients who had lower 25(OH)D levels 41 . In the two cases described, hypothyroidism, Grave's disease and immunological skin disease occurred simultaneously (Poly autoimmunity) 14 .…”

“…In an overview of alopecia in PwMS treated with DMT, 117 cases with AA after ALEM could be registered. Ruiz et al report three cases of AA and one case of AT, with one case showing autoimmune hypothyroidism 14 . Since not all cases are published by healthcare providers, the number can be expected to be higher.…”

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

“…Of note, several rare but potentially fatal autoimmune conditions, opportunistic infections, and acute cerebrovascular disorders have been reported in postmarketing studies. [16][17][18] While ALEM provides positive clinical benefits regardless of age, there are age-related increases of serious infections, malignancies, and deaths. 19 Our study aimed to investigate disease course, safety aspects, and long-term outcomes of patients with MS treated with ALEM in Austria.…”

“…Moreover, major adverse events (AEs) in the pivotal trials included infusion‐associated reactions, autoimmune disorders (thyroid, hematological and renal disorders), and infections. Of note, several rare but potentially fatal autoimmune conditions, opportunistic infections, and acute cerebrovascular disorders have been reported in postmarketing studies 16–18 . While ALEM provides positive clinical benefits regardless of age, there are age‐related increases of serious infections, malignancies, and deaths 19 …”