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Graves’ disease induced by Alemtuzumab in relapsing–remitting multiple sclerosis patients: an observational study in a reference center

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Abstract

Objectives

Graves’ disease induced by Alemtuzumab (GD-IA) is one of the most frequently observed adverse events in patients with multiple sclerosis (MS) treated with this drug. The aim of this study is the sequencing and description of these events, along with the identification of the risk factors leading to their development.

Materials and methods

We conducted a retrospective observational study identifying patients with relapsing–remitting multiple sclerosis (RRMS) and GD-IA, studying their baseline clinical features and variables related to the natural history of the disease.

Results

A total of 121 participants treated with Alemtuzumab were included, of whom 41 developed GD-IA (33.9%). A higher percentage of first-degree relatives with autoimmune thyroid disease was documented in the subgroup who developed the abovementioned event (14.6% vs 1.5%; p < 0.01). A total of 70.7% of patients diagnosed with GD-IA (n = 29/41) had fluctuations in thyroid function during follow-up, and 24.4% (n = 10/41) required total thyroidectomy for resolution of the condition. In 54.8% of participants diagnosed with GD-IA, a pattern of significant TSH decline was identified in the month prior to diagnosis of the event, with high predictive ability and associated with a more favorable clinical course (fewer weeks to normalization of thyroid function, HR = 8.99; 95% CI [2.11–38.44]; p = 0.0003).

Conclusion

GD-IA has an atypical course compared to classical forms of the disease. The identification of risk factors for the development of the disease before starting treatment with Alemtuzumab and early monitoring of thyroid function once this treatment is initiated prove to be useful strategies in the diagnosis and clinical management of this condition.

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Acknowledgements

The authors would like to thank Alicia Muñoz Fernandez for her help in translating and editing this manuscript.

Funding

The authors declare that they have not received any financial support for the conduct of the research and/or preparation of this article.

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Authors and Affiliations

  1. Endocrinology and Nutrition Department, University Hospital Virgen Macarena, Seville, Spain

    P. Rodríguez de Vera Gómez, J. J. García-González, R. Ravé-García, A. Torres-Cuadro, C. García-García & T. Martín-Hernández

  2. Neurology Department, University Hospital Virgen Macarena, Seville, Spain

    R. López Ruiz & S. Eichau-Madueño

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  1. P. Rodríguez de Vera Gómez
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Correspondence to P. Rodríguez de Vera Gómez.

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Rodríguez de Vera Gómez, P., García-González, J.J., Ravé-García, R. et al. Graves’ disease induced by Alemtuzumab in relapsing–remitting multiple sclerosis patients: an observational study in a reference center. J Endocrinol Invest 45, 1977–1990 (2022). https://doi.org/10.1007/s40618-022-01832-4

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