Secondary autoimmune diseases following alemtuzumab therapy for multiple sclerosis

Abstract

Alemtuzumab is a humanized monoclonal antibody that causes prolonged lymphopenia. In a recent Phase III trial, alemtuzumab was shown to reduce both the annualized relapse rate and the rate of sustained accumulation of disability by over 70% when compared with IFN-β1a. However, the drug is associated with thyroid autoimmunity in approximately a third of treated patients, as well as other secondary autoimmune conditions in smaller numbers. Secondary autoimmunity typically arises during reconstitution of the lymphocyte repertoire. Individuals with high baseline circulating levels of IL-21 are at highest risk of developing autoimmunity following treatment with alemtuzumab.

Keywords::

• alemtuzumab
• autoimmunity
• IL-21
• immune thrombocytopenic purpura
• ITP
• lymphopenia
• multiple sclerosis
• thyroid

Financial & competing interests disclosure

A Coles is funded in part by the National Institute for Health Research Biomedical Research Centre (Cambridge, UK) and has received consulting fees and lecture fees from GSK, Genzyme and Merk-Serono; and institutional grant support from Genzyme and UCB-Celltech. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.