Contributions
Abstract: EP1666
Type: Poster Sessions
Abstract Category: Therapy - Risk management for disease modifying treatments
Introduction: Previously reported autoimmune disorders following alemtuzumab therapy include thyroiditis, glomerulonephritis, and autoimmune thrombocytopenic purpura, and have been described as mono-phasic disorders.
Objective: to describe a case of recurrent uveitis occurring in a woman affected by multiple sclerosis, occurring after alemtuzumab therapy.
Methods/Aims: We report for the first time a case of anterior uveitis presenting one month after the first cycle of Alemtuzumab that recurred after the second and fifth month from therapy.
Results: We describe a 39-year-old Caucasian woman affected by MS according to current criteria, whose disease course was not modified by previous treatments with beta interferon and glatiramer. In July 2017 she began Alemtuzumab according to standard treatment protocol. She underwent to standard prophylaxis with acyclovir. Three weeks after last Alemtuzumab infusion, the patient presented pain, redness and decreased visual acuity in the right eye. Slit lamp examination identified protein Tyndall effect and the presence of keratin precipitates, compatible with the diagnosis of anterior uveitis that recovered after steroid therapy. Two similar episodes recurred 2 and 5 months later. HLAB27 antigen, ACE, PCR for viruses were all negative. A diagnosis was made of recurrent bilateral anterior uveitis that lasted in a consistent reduction of visual acuity. Peripheral blood samples study showed an increase in lymphocytic CD28+ expression, significantly higher compared to unaffected controls and also to another MS patient treated with alemtuzumab who did not show signs of autoimmune disorders. A further blood sample performed more than three months after complete stabilization of the last episode of uveitis, showed an initial decrease of CD28+ lymphocytic expression.
Conclusion: This is the first report to our knowledge, describing a new auto immune disorder which appeared indeed to relapse even after steroid therapy was administered. The sustained increase of activated CD28+ cells, which have been associated to uveitis pathogenesis, during the recovery phase from lymphocytes depletion determined by alemtuzumab, may explain the recurrence of the uveitis observed in this patient.
Disclosure: Erika Portera has nothing to disclose.
Paolo Ragonese has served on advisory boards for Biogen, Roche, TEVA, Sanophy-Genzyme, Merck, and Novartis and has received travel grants and/or speaker honoraria from Merck Serono, Teva, Biogen, Sanofi, Genzyme and Novartis.
Diana Di Liberto, Alessia Bianchi, Sabrina Realmuto, Giulia Vazzoler, Francesco Dieli: have nothing to disclose.i
Giuseppe Salemi has served on advisory boards for Biogen, Roche, TEVA, Sanophy-Genzyme, Merck, and Novartis and has received travel grants and/or speaker honoraria from Merck Serono, Teva, Biogen, Sanofi, Genzyme and Novartis.
Abstract: EP1666
Type: Poster Sessions
Abstract Category: Therapy - Risk management for disease modifying treatments
Introduction: Previously reported autoimmune disorders following alemtuzumab therapy include thyroiditis, glomerulonephritis, and autoimmune thrombocytopenic purpura, and have been described as mono-phasic disorders.
Objective: to describe a case of recurrent uveitis occurring in a woman affected by multiple sclerosis, occurring after alemtuzumab therapy.
Methods/Aims: We report for the first time a case of anterior uveitis presenting one month after the first cycle of Alemtuzumab that recurred after the second and fifth month from therapy.
Results: We describe a 39-year-old Caucasian woman affected by MS according to current criteria, whose disease course was not modified by previous treatments with beta interferon and glatiramer. In July 2017 she began Alemtuzumab according to standard treatment protocol. She underwent to standard prophylaxis with acyclovir. Three weeks after last Alemtuzumab infusion, the patient presented pain, redness and decreased visual acuity in the right eye. Slit lamp examination identified protein Tyndall effect and the presence of keratin precipitates, compatible with the diagnosis of anterior uveitis that recovered after steroid therapy. Two similar episodes recurred 2 and 5 months later. HLAB27 antigen, ACE, PCR for viruses were all negative. A diagnosis was made of recurrent bilateral anterior uveitis that lasted in a consistent reduction of visual acuity. Peripheral blood samples study showed an increase in lymphocytic CD28+ expression, significantly higher compared to unaffected controls and also to another MS patient treated with alemtuzumab who did not show signs of autoimmune disorders. A further blood sample performed more than three months after complete stabilization of the last episode of uveitis, showed an initial decrease of CD28+ lymphocytic expression.
Conclusion: This is the first report to our knowledge, describing a new auto immune disorder which appeared indeed to relapse even after steroid therapy was administered. The sustained increase of activated CD28+ cells, which have been associated to uveitis pathogenesis, during the recovery phase from lymphocytes depletion determined by alemtuzumab, may explain the recurrence of the uveitis observed in this patient.
Disclosure: Erika Portera has nothing to disclose.
Paolo Ragonese has served on advisory boards for Biogen, Roche, TEVA, Sanophy-Genzyme, Merck, and Novartis and has received travel grants and/or speaker honoraria from Merck Serono, Teva, Biogen, Sanofi, Genzyme and Novartis.
Diana Di Liberto, Alessia Bianchi, Sabrina Realmuto, Giulia Vazzoler, Francesco Dieli: have nothing to disclose.i
Giuseppe Salemi has served on advisory boards for Biogen, Roche, TEVA, Sanophy-Genzyme, Merck, and Novartis and has received travel grants and/or speaker honoraria from Merck Serono, Teva, Biogen, Sanofi, Genzyme and Novartis.