News for alemtuzumabers

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Prof G what can be done to manage my hyperthyroidism if I want to fall pregnant?

Carbimazole is associated with an increased risk of congenital malformations, especially when administered in the first trimester of pregnancy and at high doses. Women of childbearing potential should use effective contraception during treatment with carbimazole.

Carbimazole: increased risk of congenital malformations; strengthened advice on contraception

As you know about 40% of women treated with alemtuzumab go onto to develop hyperthyroidism. The number one drug for controlling thyrotoxicosis is carbimazole. The fact that it is teratogenic is a problem as a lot of women with MS choose to be treated with alemtuzumab so that they can fall pregnant safely off a DMT.

Endocrinologists will have to rely on using propylthiouracil another oral medication that is used to manage hyperthyroidism. Although propylthiouracil may be given in pregnancy it crosses the placenta and in high doses may cause foetal goitre and hypothyroidism, therefore the lowest possible dose should be given and thyroid function monitored every 4-6 weeks to maintain optimum control. Propylthiouracil also transfers to breast milk but this does not necessarily preclude breastfeeding. Neonatal development and infant thyroid function should be closely monitored.

The management of MS gets more complex. I am becoming an endocrinologist in my spare time 😉

About the author

Gavin

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

9 comments

  • Are there other thyroid drugs besides those two that could be used safely during the pregnancy of someone who took alemtuzumab?

  • Hi as someone who has developed Graves disease from alemtuzumab treatment I think this is unfairly alarming. Having a very efficient endocrinologist he has spoken of the growing numbers of Alemtuzumab treated patients and if the female patients wish to become pregnant the radioactive iodine option which removes the thyroid and then requires only thyroxine to be taken thus taking away the need for carbimazole would be the way forward
    In all honesty if Alemtuzumab stops your MS treating a thyroid problem is a small price to pay.
    In my opinion overactive thyroid does not mean you should not get pregnant if treated with the radioactive iodine option.
    Surely hsct which is currently seen as the best option if you can get it will also cause problems potentially
    Why are you so anti alemtuzumab?

      • You know me well. I am actually in favour of treating MS actively and effectively. It doesn’t really how you get treated as long as you are treated.

  • OTT post. You seem to blow hot and cold with Alemtuzumab. I got Graves and eventually was treated with radioactive iodine. I pop one tiny pill each morning and get my thyroid checked once a year. I’ve had no relapses since my first of two infusions some 12 years ago. EDSS is stable and MRI shows no new activity. My excellent neurologist sees me once a year and classifies me as inactive RRMS. I don’t think about my MS much at all – very different pre-Alemtuzumab when my frequent relapses were very disabling. There’s many stories similar to mine and I’m so thankful for my neurology team in Cambridge. You need to balance your scaremongering. It’s all very well listing side effects but in my experience MS has the worst side effects and needs to be stopped in it’s tracks. Thankfully Alemtuzumab appears to have done this for me. It may not work for everyone or be the choice of some, but it’s been a life changer for me.

By Gavin

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