Alemtuzumab induces severe orbitopathy in relapsing-remitting multiple sclerosis
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany..
CONTEXT: Treatment with Alemtuzumab (ALZ) in patients with Relapsing-Remitting Multiple Sclerosis (RRMS) is associated with the development of ALZ-induced Graves' disease (GD-ALZ). Some cases may develop associated Graves´ Orbitopathy (GO-ALZ), with possible visual compromise.
AIM: The aim of this study was to describe the main clinical and biochemical characteristics of GD-ALZ, as well as the clinical course of a case series of GO-ALZ METHODS: This study is a retrospective observational study, carried out in a reference hospital for the care of patients with RRMS in Spain. Cases treated with ALZ in the period 2014-2022 were included. GO-ALZ cases were identified among those with clinical symptoms compatible with thyroid eye disease after initiating ALZ treatment.
RESULTS: A total of 135 cases, with a mean follow-up of 69.6 months after the first ALZ cycle, were included. The incidence of GD-ALZ was 32.6% (44/135), with a predominance of women (77.3%) and mean age of 41.9 years. The presence of first-degree relatives with hypothyroidism was identified as risk factor for the development of GD-ALZ (adjusted P-value: 0.02). GO-ALZ was diagnosed in 6 cases (incidence: 13.6%), of which 3 had severe clinical forms of GO, requiring anti-IL-6 treatment. A favorable response was reported in all of them, with a significant decrease in disease activity and improvement in proptosis.
CONCLUSIONS: We report one of the largest cohorts of GD-ALZ and GO-ALZ cases. The diagnosis of these entities should be taken into account in patients treated with Alemtuzumab, given the risk of developing severe clinical forms. In moderate-severe forms of GO-ALZ, drugs with anti-IL-6 activity are a safe and effective option.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:271 |
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| Enthalten in: |
Journal of neurology - 271(2024), 1 vom: 04. Jan., Seite 486-496 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Rodríguez de Vera Gómez, Pablo [VerfasserIn] |
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| Links: |
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| Themen: |
3A189DH42V |
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| Anmerkungen: |
Date Completed 08.01.2024 Date Revised 05.04.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s00415-023-11995-6 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM362696047 |
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| 100 | 1 | |a Rodríguez de Vera Gómez, Pablo |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Alemtuzumab induces severe orbitopathy in relapsing-remitting multiple sclerosis |
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| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany. | ||
| 520 | |a CONTEXT: Treatment with Alemtuzumab (ALZ) in patients with Relapsing-Remitting Multiple Sclerosis (RRMS) is associated with the development of ALZ-induced Graves' disease (GD-ALZ). Some cases may develop associated Graves´ Orbitopathy (GO-ALZ), with possible visual compromise | ||
| 520 | |a AIM: The aim of this study was to describe the main clinical and biochemical characteristics of GD-ALZ, as well as the clinical course of a case series of GO-ALZ METHODS: This study is a retrospective observational study, carried out in a reference hospital for the care of patients with RRMS in Spain. Cases treated with ALZ in the period 2014-2022 were included. GO-ALZ cases were identified among those with clinical symptoms compatible with thyroid eye disease after initiating ALZ treatment | ||
| 520 | |a RESULTS: A total of 135 cases, with a mean follow-up of 69.6 months after the first ALZ cycle, were included. The incidence of GD-ALZ was 32.6% (44/135), with a predominance of women (77.3%) and mean age of 41.9 years. The presence of first-degree relatives with hypothyroidism was identified as risk factor for the development of GD-ALZ (adjusted P-value: 0.02). GO-ALZ was diagnosed in 6 cases (incidence: 13.6%), of which 3 had severe clinical forms of GO, requiring anti-IL-6 treatment. A favorable response was reported in all of them, with a significant decrease in disease activity and improvement in proptosis | ||
| 520 | |a CONCLUSIONS: We report one of the largest cohorts of GD-ALZ and GO-ALZ cases. The diagnosis of these entities should be taken into account in patients treated with Alemtuzumab, given the risk of developing severe clinical forms. In moderate-severe forms of GO-ALZ, drugs with anti-IL-6 activity are a safe and effective option | ||
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Alemtuzumab | |
| 650 | 4 | |a Graves’ orbitopathy | |
| 650 | 4 | |a Hyperthyroidism | |
| 650 | 4 | |a Relapsing–remitting multiple sclerosis | |
| 650 | 4 | |a Tocilizumab | |
| 650 | 7 | |a Alemtuzumab |2 NLM | |
| 650 | 7 | |a 3A189DH42V |2 NLM | |
| 700 | 1 | |a Méndez Muros, Mariola |e verfasserin |4 aut | |
| 700 | 1 | |a Torres Cuadro, Alberto |e verfasserin |4 aut | |
| 700 | 1 | |a Toyos Sáenz de Miera, Francisco Javier |e verfasserin |4 aut | |
| 700 | 1 | |a López Ruiz, Rocío |e verfasserin |4 aut | |
| 700 | 1 | |a Guerrero Vázquez, Raquel |e verfasserin |4 aut | |
| 700 | 1 | |a García González, Juan Jesús |e verfasserin |4 aut | |
| 700 | 1 | |a Garrido Hermosilla, Antonio Manuel |e verfasserin |4 aut | |
| 700 | 1 | |a Martín Hernández, Tomás |e verfasserin |4 aut | |
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