Contributions
Abstract: P1260
Type: Poster
Abstract Category: Therapy - disease modifying - Risk management for disease modifying treatments
Background: Alemtuzumab is a highly effective therapy for active relapsing remitting multiple sclerosis (MS) but may induce de-novo autoimmune disease, including immune thrombocytopaenic purpura (ITP) in 1-2% of treated patients. Currently there is little available data on clinical presentation and long-term outcomes of these patients outside clinical trials.
Objective: To describe the collective experience on ITP following alemtuzumab treatment across three regional UK multiple sclerosis treatment centres.
Methods: Cases identified in the MS centres in Greater Manchester, Liverpool and Cardiff were pooled for this study. ITP was identified via centre-specific monitoring protocols that included regular platelet counts and review of patient reported symptoms suggesting impaired haemostasis.
Results: Six patients (F:M=4:2) were identified across a combined treated cohort of 235 (2.6%). Mean age at treatment was 32.5 years (range 20-42). One patient was treated at diagnosis, two were treatment-naïve but received alemtuzumab 2 and 8 years after diagnosis, and three had previously been treated with other licensed MS drugs. Patients had very active disease, with a mean 4 relapses (range 2-8) in the two years pre-treatment. Baseline EDSS scores indicate accrual of significant disability by time of treatment initiation (mean 4.8, range 3.5-6.5). All pre-treatment platelet counts were normal (range 184-334). Thrombocytopaenia occurred at a median 6 months following most recent infusion (range 1-24). Platelet counts at nadir ranged widely (4 to 41x103) and 4 patients developed severe thrombocytopaenia (< 20x103). Three patients required treatment with standard first line ITP therapy, while platelet counts recovered spontaneously in the remainer. There were no haemorrhagic complications (including one ITP case during pregnancy) and all 6 patients achieved remission. However 3 patients relapsed, 2 cases requiring further therapy. Two patients developed additional autoimmune comorbidities.
Conclusions: A robust surveillance programme with monthly platelet counts, patient/ physician education on vigilance to relevant signs and symptoms, and involvement of local haematology expertise are integral to a safe alemtuzumab service for MS, allowing for early detection and management of ITP. Our patient experience suggests sustained remission after ITP therapy is not always the norm and that ITP may be followed by other autoimmune adverse events in some cases.
Disclosure: Adrian Pace: nothing to disclose
David Rog: nothing to disclose
Paul Talbot: nothing to disclose
Tatiana Mihalova: nothing to disclose
Nazar Sharaf: nothing to disclose
Sonya Ravenscroft: nothing to declare
Martin Wilson: nothing to disclose
Mark Willis: nothing to disclose
Neil Robertson: nothing to disclose
Abstract: P1260
Type: Poster
Abstract Category: Therapy - disease modifying - Risk management for disease modifying treatments
Background: Alemtuzumab is a highly effective therapy for active relapsing remitting multiple sclerosis (MS) but may induce de-novo autoimmune disease, including immune thrombocytopaenic purpura (ITP) in 1-2% of treated patients. Currently there is little available data on clinical presentation and long-term outcomes of these patients outside clinical trials.
Objective: To describe the collective experience on ITP following alemtuzumab treatment across three regional UK multiple sclerosis treatment centres.
Methods: Cases identified in the MS centres in Greater Manchester, Liverpool and Cardiff were pooled for this study. ITP was identified via centre-specific monitoring protocols that included regular platelet counts and review of patient reported symptoms suggesting impaired haemostasis.
Results: Six patients (F:M=4:2) were identified across a combined treated cohort of 235 (2.6%). Mean age at treatment was 32.5 years (range 20-42). One patient was treated at diagnosis, two were treatment-naïve but received alemtuzumab 2 and 8 years after diagnosis, and three had previously been treated with other licensed MS drugs. Patients had very active disease, with a mean 4 relapses (range 2-8) in the two years pre-treatment. Baseline EDSS scores indicate accrual of significant disability by time of treatment initiation (mean 4.8, range 3.5-6.5). All pre-treatment platelet counts were normal (range 184-334). Thrombocytopaenia occurred at a median 6 months following most recent infusion (range 1-24). Platelet counts at nadir ranged widely (4 to 41x103) and 4 patients developed severe thrombocytopaenia (< 20x103). Three patients required treatment with standard first line ITP therapy, while platelet counts recovered spontaneously in the remainer. There were no haemorrhagic complications (including one ITP case during pregnancy) and all 6 patients achieved remission. However 3 patients relapsed, 2 cases requiring further therapy. Two patients developed additional autoimmune comorbidities.
Conclusions: A robust surveillance programme with monthly platelet counts, patient/ physician education on vigilance to relevant signs and symptoms, and involvement of local haematology expertise are integral to a safe alemtuzumab service for MS, allowing for early detection and management of ITP. Our patient experience suggests sustained remission after ITP therapy is not always the norm and that ITP may be followed by other autoimmune adverse events in some cases.
Disclosure: Adrian Pace: nothing to disclose
David Rog: nothing to disclose
Paul Talbot: nothing to disclose
Tatiana Mihalova: nothing to disclose
Nazar Sharaf: nothing to disclose
Sonya Ravenscroft: nothing to declare
Martin Wilson: nothing to disclose
Mark Willis: nothing to disclose
Neil Robertson: nothing to disclose