Graves' disease after treatment with alemtuzumab for multiple sclerosis.
BACKGROUND
Alemtuzumab, a humanized monoclonal antibody against CD52, is effective in the treatment of early relapsing-remitting multiple sclerosis (MS). Common adverse effects include an acute-phase reaction, infections and autoimmune diseases, including thyroid disorders.


METHODS
Patients from two phase 3 trials (CARE MS 1 and 2, n=15) were studied in a clinical research center.


METHODS
Five out of fifteen patients developed severe Graves' disease after a mean of 32 months following the first alemtuzumab treatment.


METHODS
Thyroid function tests and thyroid antibodies were assessed. In addition, endocrine tests and measurement of antibodies indicative of autoimmunity were performed.


RESULTS
Of the five patients developing Graves' disease, four patients were initially treated with antithyroid drugs, whereas the fifth patient had mild and self-limiting hyperthyroidism. Of the four patients treated with antithyroid drugs, one is currently under medical treatment in a dose-reducing regimen, whereas three patients underwent near-total thyroidectomy 2, 12 and 16 months later. Two patients developed endocrine ophthalmopathy. Pituitary, adrenal and gonadal hormones were normal in all patients. While four out of five patients were positive for several other autoantibodies, none developed other autoimmune diseases.


CONCLUSIONS
Since autoimmune thyroid disease is common after alemtuzumab treatment for MS, pretreatment screening and careful follow-up may allow for early diagnosis and treatment.
Elena
E
Tsourdi
Matthias
M
Gruber
Martina
M
Rauner
Judith
J
Blankenburg
Tjalf
T
Ziemssen
Lorenz C
LC
Hofbauer
D000328:Adult; D000074323:Alemtuzumab; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use; D013956:Antithyroid Agents / Q000627:therapeutic use; D005260:Female; D006111:Graves Disease / Q000139:chemically induced* / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy*; D013960:Thyroid Function Tests; D013965:Thyroidectomy
D061067:Antibodies, Monoclonal, Humanized; D013956:Antithyroid Agents; D000074323:Alemtuzumab