“The following post is in response to yesterday’s ClinicSpeak post on natalizumab vs. alemtuzumab and the question about secondary autoimmunity post-alemtuzumab.”
The following are some excerpts from the paper in relation to secondary autoimmunity:
….Clinical autoimmune disease developed in 41 patients (48%, omitting one patient with pre-existing thyroid disease); a further 12 (14%) patients developed sustained novel autoantibodies (9 anti-nuclear antibodies and 3 anti-thyroid peroxidase antibodies) with no evidence of associated clinical disease….
….. This occurred a median of 16 months since last treatment …
…. Autoimmunity was not associated with the number of alemtuzumab treatment cycles administered….
….. Thyroid autoimmunity developed in 41% of whom 63% had hyperthyroidism (Graves’ disease); 1 patient had transient thyroiditis, and 34% developed primary hypothyroidism with positive antithyroid peroxidase antibodies…
… Most patients were treated medically; three with Graves’ disease also required radio-iodine treatment…..
….. Three patients (3.5%) developed immune thrombocytopenic purpura (ITP)….
….. Asymptomatic autoimmune neutropenia developed in a single patient 3 months after her second alemtuzumab cycle….
….. One patient developed autoimmune haemolytic anaemia, which was detected on full blood count monitoring..
…. One patient developed Goodpasture’s disease requiring renal transplantation….
“In addition to these cases I am aware of a patient developing bullous skin disease (bullous pemphigoid) post-alemtuzumab. Based on the spectrum of secondary autoimmune diseases that are seen in the bone marrow transplant setting, I predict that we will see thrombotic thrombocytopenic purpura (TTP), which is also a severe potentially life-threatening antibody mediated autoimmune disease of clotting, myasthenia gravis and others; however, these will be very rare.”
Epub: Tuohy et al. Alemtuzumab treatment of multiple sclerosis: long-term safety and efficacy. J Neurol Neurosurg Psychiatry. 2014 May 21. pii: jnnp-2014-307721. doi: 10.1136/jnnp-2014-307721.
OBJECTIVES: Alemtuzumab is a newly licensed treatment of active relapsing-remitting multiple sclerosis (RRMS) in Europe, which in phase II and III studies demonstrated superior efficacy over β-interferon in reducing disability progression over 2-3 years. In this observational cohort study, we sought to describe our longer-term experience of the efficacy and safety of alemtuzumab in active RRMS.
METHODS: Clinical and laboratory data including serial Expanded Disability Status Scale (EDSS) assessments, from all 87 MSers treated with alemtuzumab on investigator-led studies in Cambridge, UK, from 1999 to 2012, were collected. The occurrence of adverse events including secondary autoimmunity, malignancy and death, and pregnancy outcomes was recorded. Baseline variables including age, disease duration and relapse rate were compared in univariate and logistic regression analyses between groups with different disability outcomes.