Prevalence, Risk Factors, and Clinical and Biochemical Characteristics of Alemtuzumab-Induced Graves Disease.

Autor:	Ueland GÅ; Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway., Ueland HO; Department of Ophthalmology, Haukeland University Hospital, 5021 Bergen, Norway., Stokland AM; Department of Endocrinology, Stavanger University Hospital, 4019 Stavanger, Norway., Bhan A; Department of Neurology, Stavanger University Hospital, 4019 Stavanger, Norway., Schønberg A; Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway., Sollid ST; Department of Medicine, Drammen Hospital, Vestre Viken Health Trust, 3004 Drammen, Norway., Morgas DE; Department of Ophthalmology, Drammen Hospital, Vestre Viken Health Trust, 3004 Drammen, Norway., Holmøy T; Department of Neurology, Akershus University Hospital, 1478 Oslo, Norway.; Institute of Clinical Medicine, University of Oslo, 0313 Oslo, Norway., Lima K; Department of Medicine, Akershus University Hospital, 1478 Oslo, Norway., Methlie P; Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway.; Department of Clinical Medicine, University of Bergen, 5009 Bergen, Norway., Løvås K; Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway., Torkildsen Ø; Department of Clinical Medicine, University of Bergen, 5009 Bergen, Norway.; Department of Neurology, Neuro-SysMed, Haukeland University Hospital, 5021 Bergen, Norway., Husebye ES; Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway.; Department of Clinical Medicine, University of Bergen, 5009 Bergen, Norway.
Jazyk:	angličtina
Zdroj:	The Journal of clinical endocrinology and metabolism [J Clin Endocrinol Metab] 2024 Jan 18; Vol. 109 (2), pp. 344-350.
DOI:	10.1210/clinem/dgad540
Abstrakt:	Objective: Atypical Graves disease (GD) is a common complication in multiple sclerosis (MS) patients treated with alemtuzumab. We present epidemiological, clinical, and biochemical characteristics of alemtuzumab-induced GD. Methods: Retrospective follow-up study of MS patients treated with alemtuzumab from 2014 to 2020, including clinical course of GD, pregnancy outcome, and thyroid eye disease (TED). Results: We enrolled 183 of 203 patients (90%, 68% women) treated with alemtuzumab at 4 hospitals in Norway. Seventy-five (41%) developed thyroid dysfunction, of whom 58 (77%) had GD. Median time from the first dose of alemtuzumab to GD diagnosis was 25 months (range, 0-64). Twenty-four of 58 GD patients (41%) had alternating phases of hyper- and hypothyroidism. Thyrotropin receptor antibodies became undetectable in 23 of 58 (40%) and they could discontinue antithyroid drug treatment after a median of 22 (range, 2-58) months. Conversely, 26 (44%) had active disease during a median follow-up of 39 months (range, 11-72). Two patients (3%) received definitive treatment with radioiodine, 6 (10%) with thyroidectomy. Nine developed TED (16%), 7 had mild and 2 moderate to severe disease. Four patients completed pregnancy, all without maternal or fetal complications. Patients who developed GD had a lower frequency of new MS relapses and MRI lesions than those without. Conclusion: GD is a very common complication of alemtuzumab treatment and is characterized by alternating hyper- and hypothyroidism. Both remission rates and the prevalence of TED were lower than those reported for conventional GD. Pregnancies were uncomplicated and GD was associated with a lower risk of subsequent MS activity. (© The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society.)
Databáze:	MEDLINE
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