Contributions
Abstract: EP1670
Type: Poster Sessions
Abstract Category: Therapy - Risk management for disease modifying treatments
Alemtuzumab has been demonstrated to reduce the risks of relapse and accumulation of sustained disability in MS-patients compared to β-interferon. With alemtuzumab autoimmune side-effects commonly affect the thyroid (20-30%) and usually occur during the first three after treatment. Recent data have shown that mild neutropenia is observed in 16% of MS-patients whereas severe neutropenia occurred in 0,6 %. We aimed to evaluate the serological parameters, rate, timing of the development of autoimmune manifestations after the first-year of alemtuzumab treatment for MS in our cohort study. We analyzed prospectively clinical and serological data from 16 MS-patients treated with alemtuzumab with median follow-up of 28-months. Four out of sixteen patients (25%) developed thyroid dysfunction after a mean of 11-months following the first alemtuzumab treatment. One patient developed Graves' disease with increased anti-TSI antibodies (11th-month) and another developed Hashimoto´s disease (12th-month). Hypothyroidism in the absence of antibodies was noticed in one patient (13th-month), whereas another patient showed high titers of anti-TG antibodies (6th-month) with normal levels of thyroid hormones. One patient developed generalized erythema-multiforme (2th-month) which resolved after prezolon and antihistamine treatment. Finally, 70-days after the last alemtuzumab-administration one patient displayed neutropenia (500 neutrophils/µL) in the absence of B-cells (0,6% of total lymphocytes), low values of CD4-T-cells (6,6%) and predominance of CD8-T-cells (48%) and NK-cells (47%) with large-granular lymphocytes (LGL) predominating in the blood-smear examination. Due to prolonged neutropenia (5-days) the patient was placed on low-dose corticosteroids leading to sustained remission. Autoimmunity following alemtuzumab therapy in MS appears to occur as part of an immune-reconstitution syndrome. A range of hematologic, dermatological and thyroid side-effects we observed. Patients experienced an early thyroid impairment, a phenomenon that raises the need for regular thyroid retesting every 3-months. The most intriguing feature concerns the expansion of LGL cell population in the peripheral blood of one patient that developed neutropenia.
Disclosure: C. Kilidireas has received grants and honoraria from: Bayer, Biogen, Genesis Pharma, Merck-Serono, Novartis, Sanofi - Genzyme, Teva.
G. Koutsis has received research grants from Genesis Pharma and Teva, consultation fees, advisory board renumeration and honoraria from Genzyme, Genesis Pharma, Teva and Novartis.
M.E. Evangelopoulos has provided consultation services for and received honoraria from Novartis, Biogen and Teva.
M. Anagnostouli has received research grants from Biogen, Merck-Serono, Novartis, Teva, Bayer and Genzyme, as well as lecture-fees from Novartis, Teva, Biogen and Genzyme.
E. Andreadou has received research grants from Biogen, Merck-Serono, Novartis, and Sanofi Aventis, as well as lecture-fees from Teva.
D. Tzanetakos : nothing to disclose
J. Tzartos : nothing to disclose
A. Vakrakou: nothing to disclose
Abstract: EP1670
Type: Poster Sessions
Abstract Category: Therapy - Risk management for disease modifying treatments
Alemtuzumab has been demonstrated to reduce the risks of relapse and accumulation of sustained disability in MS-patients compared to β-interferon. With alemtuzumab autoimmune side-effects commonly affect the thyroid (20-30%) and usually occur during the first three after treatment. Recent data have shown that mild neutropenia is observed in 16% of MS-patients whereas severe neutropenia occurred in 0,6 %. We aimed to evaluate the serological parameters, rate, timing of the development of autoimmune manifestations after the first-year of alemtuzumab treatment for MS in our cohort study. We analyzed prospectively clinical and serological data from 16 MS-patients treated with alemtuzumab with median follow-up of 28-months. Four out of sixteen patients (25%) developed thyroid dysfunction after a mean of 11-months following the first alemtuzumab treatment. One patient developed Graves' disease with increased anti-TSI antibodies (11th-month) and another developed Hashimoto´s disease (12th-month). Hypothyroidism in the absence of antibodies was noticed in one patient (13th-month), whereas another patient showed high titers of anti-TG antibodies (6th-month) with normal levels of thyroid hormones. One patient developed generalized erythema-multiforme (2th-month) which resolved after prezolon and antihistamine treatment. Finally, 70-days after the last alemtuzumab-administration one patient displayed neutropenia (500 neutrophils/µL) in the absence of B-cells (0,6% of total lymphocytes), low values of CD4-T-cells (6,6%) and predominance of CD8-T-cells (48%) and NK-cells (47%) with large-granular lymphocytes (LGL) predominating in the blood-smear examination. Due to prolonged neutropenia (5-days) the patient was placed on low-dose corticosteroids leading to sustained remission. Autoimmunity following alemtuzumab therapy in MS appears to occur as part of an immune-reconstitution syndrome. A range of hematologic, dermatological and thyroid side-effects we observed. Patients experienced an early thyroid impairment, a phenomenon that raises the need for regular thyroid retesting every 3-months. The most intriguing feature concerns the expansion of LGL cell population in the peripheral blood of one patient that developed neutropenia.
Disclosure: C. Kilidireas has received grants and honoraria from: Bayer, Biogen, Genesis Pharma, Merck-Serono, Novartis, Sanofi - Genzyme, Teva.
G. Koutsis has received research grants from Genesis Pharma and Teva, consultation fees, advisory board renumeration and honoraria from Genzyme, Genesis Pharma, Teva and Novartis.
M.E. Evangelopoulos has provided consultation services for and received honoraria from Novartis, Biogen and Teva.
M. Anagnostouli has received research grants from Biogen, Merck-Serono, Novartis, Teva, Bayer and Genzyme, as well as lecture-fees from Novartis, Teva, Biogen and Genzyme.
E. Andreadou has received research grants from Biogen, Merck-Serono, Novartis, and Sanofi Aventis, as well as lecture-fees from Teva.
D. Tzanetakos : nothing to disclose
J. Tzartos : nothing to disclose
A. Vakrakou: nothing to disclose