Contributions
Abstract: EP1635
Type: Poster Sessions
Abstract Category: Therapy - Long-term treatment monitoring
Introduction: Alemtuzumab, a humanised monoclonal antibody targeting CD52 that selectively depletes T- and B- lymphocytes, can be associated with secondary autoimmune conditions. Here, we describe a case of autoimmune alopecia totalis following exposure to alemtuzumab. Although alopecia is recognised in patients treated with alemtuzumab, generalised alopecia has rarely been reported in the literature. Along with an unclear mechanism, this complication understandably can cause significant distress to the MS patient.
Case: A 34-year-old woman with relapsing-remitting MS and no history of other autoimmune disease received alemtuzumab therapy after two disabling relapses and radiological evidence of disease activity whilst on treatment with glatiramer acetate. There were no initial complications, post infusion screening was uneventful and she demonstrated clinical and radiological disease stability. Two years after her second course of alemtuzumab she developed subacute onset alopecia areata progressing over several weeks to alopecia totalis. A trial of Tacrolimus 0.03% was unsuccessful but six months post onset she began to make a spontaneous, although limited recovery.
Conclusion: This case highlights the importance of counselling patients, prior to alemtuzumab therapy, on all potential complications including alopecia. The temporal relation of alopecia onset to alemtuzumab treatment in this case was in keeping with other autoimmune complications of alemtuzumab and patients should undergo active monitoring for at least 4 years after the last course. Clinicians should be aware of potential treatments for autoimmune alopecia areata and have local referral systems in place for dermatology services. The element of reversibility in hair loss would differentiate this from androgenic alopecia, which may provide some reassurance to the MS patient.
Disclosure: Wilson KW Fung underwent a Movement Disorders Fellowship in Melbourne, Australia (2017-2018, Ipsen). Gillian Ingram received honoraria and travel expenses from Biogen, Genzyme and Merck and served on advisory board for Merck. Owen R Pearson received honoraria and travel expenses from Biogen, Bayer, Genzyme, Merck, Novartis, Roche and Teva and served on advisory boards for Biogen, Novartis, Merck and Roche.
Abstract: EP1635
Type: Poster Sessions
Abstract Category: Therapy - Long-term treatment monitoring
Introduction: Alemtuzumab, a humanised monoclonal antibody targeting CD52 that selectively depletes T- and B- lymphocytes, can be associated with secondary autoimmune conditions. Here, we describe a case of autoimmune alopecia totalis following exposure to alemtuzumab. Although alopecia is recognised in patients treated with alemtuzumab, generalised alopecia has rarely been reported in the literature. Along with an unclear mechanism, this complication understandably can cause significant distress to the MS patient.
Case: A 34-year-old woman with relapsing-remitting MS and no history of other autoimmune disease received alemtuzumab therapy after two disabling relapses and radiological evidence of disease activity whilst on treatment with glatiramer acetate. There were no initial complications, post infusion screening was uneventful and she demonstrated clinical and radiological disease stability. Two years after her second course of alemtuzumab she developed subacute onset alopecia areata progressing over several weeks to alopecia totalis. A trial of Tacrolimus 0.03% was unsuccessful but six months post onset she began to make a spontaneous, although limited recovery.
Conclusion: This case highlights the importance of counselling patients, prior to alemtuzumab therapy, on all potential complications including alopecia. The temporal relation of alopecia onset to alemtuzumab treatment in this case was in keeping with other autoimmune complications of alemtuzumab and patients should undergo active monitoring for at least 4 years after the last course. Clinicians should be aware of potential treatments for autoimmune alopecia areata and have local referral systems in place for dermatology services. The element of reversibility in hair loss would differentiate this from androgenic alopecia, which may provide some reassurance to the MS patient.
Disclosure: Wilson KW Fung underwent a Movement Disorders Fellowship in Melbourne, Australia (2017-2018, Ipsen). Gillian Ingram received honoraria and travel expenses from Biogen, Genzyme and Merck and served on advisory board for Merck. Owen R Pearson received honoraria and travel expenses from Biogen, Bayer, Genzyme, Merck, Novartis, Roche and Teva and served on advisory boards for Biogen, Novartis, Merck and Roche.