Manso Jacopo, Muller Ilaria, Mian Caterina
Eur Thyroid J. 2025 Jun 10;14(3). doi: 10.1530/ETJ-25-0007. Print 2025 Jun 1.
Alemtuzumab is a powerful anti-CD52 drug that is an established treatment option in patients with multiple sclerosis due to its proven efficacy. However, in about 50% of patients, the use of alemtuzumab is burdened by the development of secondary autoimmune thyroid diseases, constituting a range of alemtuzumab-induced autoimmune thyroid diseases (AIATDs). Graves' disease (GD) is the most common AIATD, with an incidence of approximately 60%, and presents different characteristics from the conventional form. Indeed, GD with a fluctuating course is significantly more prevalent (15-50%), which poses a major challenge for physicians in its management. Other AIATDs also exhibit distinct features compared to their conventional counterparts; notably, hypothyroidism is frequently associated with TSH-receptor blocking antibodies, and alemtuzumab-induced GD demonstrates a higher rate of fluctuating course and potential for spontaneous remission. Alemtuzumab-induced thyroid eye disease (TED) is less common than conventional TED, with similar clinical and management characteristics. In this review, we summarize the latest evidence, also from real-world studies, with a focus on clinical management and possible predictors of AIATDs.
阿仑单抗是一种强效抗CD52药物，因其已证实的疗效，是多发性硬化症患者既定的治疗选择。然而，在约50%的患者中，使用阿仑单抗会受到继发性自身免疫性甲状腺疾病的影响，构成一系列阿仑单抗诱导的自身免疫性甲状腺疾病（AIATD）。格雷夫斯病（GD）是最常见的AIATD，发病率约为60%，且呈现出与传统形式不同的特征。实际上，病程波动的GD更为普遍（15%-50%），这给医生的管理带来了重大挑战。与传统的自身免疫性甲状腺疾病相比，其他AIATD也表现出不同的特征；值得注意的是，甲状腺功能减退症常与促甲状腺激素受体阻断抗体相关，且阿仑单抗诱导的GD病程波动率更高，有自发缓解的可能。阿仑单抗诱导的甲状腺眼病（TED）比传统TED少见，具有相似的临床和管理特征。在本综述中，我们总结了最新证据，包括来自真实世界研究的证据，重点关注AIATD的临床管理和可能的预测因素。
