An analysis of case records of patients with multiple sclerosis (MS) showed that many of these patients developed thyroid dysfunction following their treatment with alemtuzumab in clinical trials, according to a study recently published in The Journal of Clinical Endocrinology & Metabolism.

The analysis reviewed alemtuzumab-induced thyroid dysfunction response to treatment as compared with that reported in conventional thyroid disease in addition to documenting the frequency, type, and course following a case study involving the treatment from May 1993 to October 2013. Thyroid dysfunction was diagnosed in 102 out of 248 (41.1%; 80 female, 22 male) participants between the ages of 20 and 60 who had received at least 1 course of alemtuzumab therapy for MS in this 20-year long clinical trial, which took place at Addenbrooke’s Hospital in Cambridge, United Kingdom, and University Hospital Wales in Cardiff, United Kingdom.

Of these 102 participants, 71.6% developed Graves disease with a median onset of 17 months (range 2-107) following their last dose of alemtuzumab, making it the most frequent thyroid disorder. Onset was variable, but the majority (89%) occurred within 36 months of the final administration of the alemtuzumab treatment, and 91% occurred within 4 years. There were detailed follow-up data (range 6-251 months) available for 71 of these 102 cases. Of these 71 participants, 52 (73.2%) developed Graves disease, all of which began antithyroid drugs. Definitive or long-term treatment was required for 30 (64%) of these participants.

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Results of this analysis reveal that, although alemtuzumab is a highly effective treatment for MS, it often prompts the onset of alemtuzumab-induced thyroid dysfunction. The majority of participants that experienced onset of thyroid dysfunction also required definitive of prolonged antithyroid drug treatment. 

Investigators suggest “close monitoring of thyroid function in alemtuzumab-treated MS patients, particularly if they develop [Graves disease], offering early definitive treatment in drug-refractory or fluctuating cases.”

REFERENCE

Pariani N, Willis M, Muller I, et al. Alemtuzumab-induced thyroid dysfunction exhibits distinctive clinical and immunological features [published online June 6, 2018]. J Clin Endocrinol Metab. doi:10.1210/jc.2018-00359