Treatment With Alemtuzumab May Frequently Induce Thyroid Dysfunction

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Approximately 41% of patients treated with alemtuzumab developed thyroid dysfunction.
Approximately 41% of patients treated with alemtuzumab developed thyroid dysfunction.

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.

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

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