Simultaneous early-onset immune thrombocytopenia and autoimmune thyroid disease following alemtuzumab treatment in relapsing-remitting multiple sclerosis. (August 2016)

• Record Type: Journal Article
• Authors: Obermann, Mark; Ruck, Tobias; Pfeuffer, Steffen; Baum, Julia; Wiendl, Heinz; Meuth, Sven G
• Is Part Of: Multiple sclerosis. Volume 22:Number 9(2016)
• Page Start: 1235
• Page End: 1241
• Publication Date: 2016-08
• Subjects: Alemtuzumab -- multiple sclerosis -- treatment safety -- adverse events -- side effects -- immune thrombocytopenia -- risk factors -- early-onset; Central nervous system -- Diseases -- Periodicals; Myelin sheath -- Diseases -- Periodicals; Inflammation -- Periodicals; Multiple sclerosis -- Periodicals; Central Nervous System Diseases -- Periodicals; Demyelinating Diseases -- Periodicals; Inflammation -- Periodicals; Multiple Sclerosis -- Periodicals; Système nerveux central -- Maladies -- Périodiques; Gaine de myéline -- Maladies -- Périodiques; Inflammation (Pathologie) -- Périodiques; Sclérose en plaques -- Périodiques; Electronic journals; 616.834005
• DOI: 10.1177/1352458516638558
• Languages: English
• ISSNs: 1352-4585

Abstract

Objective: We report two cases of patients with relapsing-remitting multiple sclerosis with early-onset thrombocytopenia and autoimmune thyroid disease after the first treatment course with 60-mg alemtuzumab. Methods: Case series and review of the literature. Results: Both patients showed severe thrombocytopenia with platelet counts of 2 × 10 9 and 11 × 10 9 /L, respectively, as well as increased thyroid antibodies within only a few months after initiating alemtuzumab treatment (11 and 9 months). Both patients responded considerably well to medical therapy including corticosteroids and intravenous immunoglobulins with slow platelet recovery over several weeks. Interestingly, both patients were previously treated with fingolimod and showed a marked lymphocytopenia that led to discontinuation. Conclusion: These cases emphasize the necessity of careful clinical surveillance and proper education of patients treated with alemtuzumab as proposed by the safety-monitoring program. Previous severe lymphocytopenia under therapy with other disease-modifying therapies may be a risk factor for the development of immune thrombocytopenia.