Tags

Type your tag names separated by a space and hit enter

Alemtuzumab-induced thyroid events in multiple sclerosis: a systematic review and meta-analysis.

Abstract

PURPOSE

Autoimmune thyroid events (ATEs) are common side effects after alemtuzumab (ALZ) therapy in patients with multiple sclerosis (MS). Our purpose was to reach more robust evidence on prevalence and outcome of the spectrum of alemtuzumab-induced autoimmune thyroid events in patients with multiple sclerosis.

METHODS

PubMed and Scopus were systematically searched through July 2019. Studies dealing with patients without personal history of thyroid dysfunctions and affected by MS treated with ALZ and reporting ATEs were selected. Data on prevalence and outcome of ATEs were extracted. A proportion of meta-analysis with random-effects model was performed.

RESULTS

Considering the overall pooled number of 1362 MS patients treated with ALZ (seven included studies), a 33% prevalence of newly diagnosed ATEs was recorded. Among all ATEs, Graves' disease (GD) was the most represented [63% of cases, 95% confidence interval (CI) 52-74%], followed by Hashimoto thyroiditis (15%, 95% CI 10-22%). Interestingly, GD showed a fluctuating course in 15% of cases (95% CI 8-25%). Of all GD, 12% (95% CI 2-42%) likely had spontaneous remission, 56% (95% CI 34-76%) required only antithyroid drugs, 22% (95% CI 13-32%) needed additional RAI, and 11% (95% CI 0.9-29%) underwent definitive surgery.

CONCLUSION

Among different categories of ATEs, Graves' hyperthyroidism was the most common thyroid dysfunction, occurring in more than half of cases. Antithyroid drugs should represent the first-line treatment for ALZ-induced GD patients. However, alemtuzumab-induced GD could not be considered as having a more favourable outcome than conventional GD, given the substantial chance to encounter a fluctuating and unpredictable course.

Authors+Show Affiliations

Unit of Endocrinology and Metabolic Diseases, University of Campania "L.Vanvitelli", 80138, Naples, Italy. lorenzo828@virgilio.it.Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy.Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.Unit of Endocrinology and Metabolic Diseases, University of Campania "L.Vanvitelli", 80138, Naples, Italy.Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.Department of Human Pathology of Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy. Unit of Endocrinology, "G. Martino" University Hospital, University of Messina, Messina, Italy.Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy.Unit of Endocrinology, "G. Martino" University Hospital, University of Messina, Messina, Italy. Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.Department of Nuclear Medicine and Thyroid Centre, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.Department of Nuclear Medicine and Thyroid Centre, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31452116

Citation

Scappaticcio, L, et al. "Alemtuzumab-induced Thyroid Events in Multiple Sclerosis: a Systematic Review and Meta-analysis." Journal of Endocrinological Investigation, 2019.
Scappaticcio L, Castellana M, Virili C, et al. Alemtuzumab-induced thyroid events in multiple sclerosis: a systematic review and meta-analysis. J Endocrinol Invest. 2019.
Scappaticcio, L., Castellana, M., Virili, C., Bellastella, G., Centanni, M., Cannavò, S., ... Trimboli, P. (2019). Alemtuzumab-induced thyroid events in multiple sclerosis: a systematic review and meta-analysis. Journal of Endocrinological Investigation, doi:10.1007/s40618-019-01105-7.
Scappaticcio L, et al. Alemtuzumab-induced Thyroid Events in Multiple Sclerosis: a Systematic Review and Meta-analysis. J Endocrinol Invest. 2019 Aug 26; PubMed PMID: 31452116.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Alemtuzumab-induced thyroid events in multiple sclerosis: a systematic review and meta-analysis. AU - Scappaticcio,L, AU - Castellana,M, AU - Virili,C, AU - Bellastella,G, AU - Centanni,M, AU - Cannavò,S, AU - Campennì,A, AU - Ruggeri,R M, AU - Giovanella,L, AU - Trimboli,P, Y1 - 2019/08/26/ PY - 2019/07/24/received PY - 2019/08/21/accepted PY - 2019/8/28/entrez KW - Alemtuzumab KW - Multiple sclerosis KW - Side effects KW - Thyroid JF - Journal of endocrinological investigation JO - J. Endocrinol. Invest. N2 - PURPOSE: Autoimmune thyroid events (ATEs) are common side effects after alemtuzumab (ALZ) therapy in patients with multiple sclerosis (MS). Our purpose was to reach more robust evidence on prevalence and outcome of the spectrum of alemtuzumab-induced autoimmune thyroid events in patients with multiple sclerosis. METHODS: PubMed and Scopus were systematically searched through July 2019. Studies dealing with patients without personal history of thyroid dysfunctions and affected by MS treated with ALZ and reporting ATEs were selected. Data on prevalence and outcome of ATEs were extracted. A proportion of meta-analysis with random-effects model was performed. RESULTS: Considering the overall pooled number of 1362 MS patients treated with ALZ (seven included studies), a 33% prevalence of newly diagnosed ATEs was recorded. Among all ATEs, Graves' disease (GD) was the most represented [63% of cases, 95% confidence interval (CI) 52-74%], followed by Hashimoto thyroiditis (15%, 95% CI 10-22%). Interestingly, GD showed a fluctuating course in 15% of cases (95% CI 8-25%). Of all GD, 12% (95% CI 2-42%) likely had spontaneous remission, 56% (95% CI 34-76%) required only antithyroid drugs, 22% (95% CI 13-32%) needed additional RAI, and 11% (95% CI 0.9-29%) underwent definitive surgery. CONCLUSION: Among different categories of ATEs, Graves' hyperthyroidism was the most common thyroid dysfunction, occurring in more than half of cases. Antithyroid drugs should represent the first-line treatment for ALZ-induced GD patients. However, alemtuzumab-induced GD could not be considered as having a more favourable outcome than conventional GD, given the substantial chance to encounter a fluctuating and unpredictable course. SN - 1720-8386 UR - https://www.unboundmedicine.com/medline/citation/31452116/Alemtuzumab-induced_thyroid_events_in_multiple_sclerosis:_a_systematic_review_and_meta-analysis L2 - https://link.springer.com/article/10.1007/s40618-019-01105-7 DB - PRIME DP - Unbound Medicine ER -