Clinical management of alemtuzumab-induced autoimmune thyroid diseases: a narrative review

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...

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Main Authors: Jacopo Manso, Ilaria Muller, Caterina Mian
Format: Article
Language:English
Published: Bioscientifica 2025-06-01
Series:European Thyroid Journal
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Online Access:https://etj.bioscientifica.com/view/journals/etj/14/3/ETJ-25-0007.xml
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author Jacopo Manso
Ilaria Muller
Caterina Mian
author_facet Jacopo Manso
Ilaria Muller
Caterina Mian
author_sort Jacopo Manso
collection DOAJ
description 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.
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spelling doaj-art-b4aa0b1f32804f2499b61b145d9176a22025-08-20T03:46:50ZengBioscientificaEuropean Thyroid Journal2235-08022025-06-0114310.1530/ETJ-25-00071Clinical management of alemtuzumab-induced autoimmune thyroid diseases: a narrative reviewJacopo Manso0Ilaria Muller1Caterina Mian2Endocrinology Unit, University Hospital S. Maria della Misericordia of Udine, Oncology Area Deparment, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, ItalyDepartment of Clinical Sciences and Community Health, University of Milan, Milan, ItalyEndocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, ItalyAlemtuzumab 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.https://etj.bioscientifica.com/view/journals/etj/14/3/ETJ-25-0007.xmlthyroidalemtuzumabthyroid eye diseasegraves’ diseasealemtuzumab-induced autoimmune thyroid diseases
spellingShingle Jacopo Manso
Ilaria Muller
Caterina Mian
Clinical management of alemtuzumab-induced autoimmune thyroid diseases: a narrative review
European Thyroid Journal
thyroid
alemtuzumab
thyroid eye disease
graves’ disease
alemtuzumab-induced autoimmune thyroid diseases
title Clinical management of alemtuzumab-induced autoimmune thyroid diseases: a narrative review
title_full Clinical management of alemtuzumab-induced autoimmune thyroid diseases: a narrative review
title_fullStr Clinical management of alemtuzumab-induced autoimmune thyroid diseases: a narrative review
title_full_unstemmed Clinical management of alemtuzumab-induced autoimmune thyroid diseases: a narrative review
title_short Clinical management of alemtuzumab-induced autoimmune thyroid diseases: a narrative review
title_sort clinical management of alemtuzumab induced autoimmune thyroid diseases a narrative review
topic thyroid
alemtuzumab
thyroid eye disease
graves’ disease
alemtuzumab-induced autoimmune thyroid diseases
url https://etj.bioscientifica.com/view/journals/etj/14/3/ETJ-25-0007.xml
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AT caterinamian clinicalmanagementofalemtuzumabinducedautoimmunethyroiddiseasesanarrativereview