Cautious Use of Alemtuzumab Advised in Younger Adults with Multiple Sclerosis

Alemtuzumab-related thyroid disease in patients with multiple sclerosis (MS) may be associated with age and brainstem involvement at MS onset, according to a study published online in Multiple Sclerosis Journal-Experimental, Translational and Clinical.

“We suggest cautious use of alemtuzumab in younger patients with MS (≤32 years) with early brainstem involvement, especially those actively planning pregnancy, where alternative therapies are readily available,” the researchers wrote.

Autoimmune thyroid disease occurs in 40% to 50% of patients with MS treated with alemtuzumab. To identify contributory factors, the researchers conducted a retrospective chart review of 52 patients.
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They found that 16 patients (30.8%) developed autoimmune thyroid disease, and nine patients developed Graves disease, which was symptomatic in seven. All but one patient with symptomatic Graves disease developed atypical, large, and rapid fluctuations in thyroid hormone levels that could not be explained solely by the effect of anti-thyroid medication, the researchers reported.

All patients with symptomatic Graves disease were age 32 years or younger when they started alemtuzumab. The researchers found that patients who started alemtuzumab younger developed thyroid disease earlier.

In addition, patients with clinical and radiological evidence of brainstem involvement at the onset of MS were 11 times more likely to develop symptomatic Graves disease compared with patients with other brainstem phenotypes.

“Alemtuzumab-induced reconstitution Graves disease may result from early and increased cross-reactivity between antigens common to the brainstem and thyroid, or presence of shared human leukocyte antigen alleles that determine brainstem and thyroid involvement,” the researchers concluded.

—Jolynn Tumolo

Reference

Yap SM, Dillon M, Crowley RK, McGuigan C. Alemtuzumab-related thyroid disease in people with multiple sclerosis is associated with age and brainstem phenotype at disease onset. Mult Scler J Exp Transl Clin. 2020;6(2):2055217320933928. doi:10.1177/2055217320933928