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Abstract Details

Scheduled IVIG in Patients Treated with Alemtuzumab Reduces Autoimmune Adverse Reactions
Multiple Sclerosis
MS and CNS Inflammatory Disease Posters (7:00 AM-5:00 PM)
222

Describe the use of IVIG in patients with multiple sclerosis who were treated with alemtuzumab
Thyroid dysfunction develops in about 40% of patients with multiple sclerosis treated with alemtuzumab at a median of 17 months after the last dose. Autoantibodies against thyroid stimulating hormone receptor, thyroperoxidase and thyroglobulin have been associated with autoimmune thyroiditis. Little is known about the use of scheduled intravenous immunoglobulin (IVIG) in patients treated with alemtuzumab to prevent development of autoimmune disease.  
Data was collected prospectively through direct patient care and chart review.
We treated twenty-four patients with alemtuzumab between 2015 and 2019. Seven patients were excluded as they did not complete the dosing schedule. Of the 17 patients who received both rounds of alemtuzumab, 9 patients received scheduled IVIG after each round (4 or more courses given over 2-5 days, average 5.9 courses) and 8 patients received no or incomplete IVIG (2 or less courses, average 0.75 courses). The average length of follow up was 33.3 months (range 19-58 months) from the last alemtuzumab infusion.  In the IVIG group, 2 of 9 (22%) patients developed autoimmune events (subclinical hyperthyroidism, Hashimoto’s) versus 4 of 8 (50%) patients in the incomplete or no IVIG group (Grave’s disease, Hashimoto’s, immune thrombocytopenic purpura). Serious infections were present in 1 of 9 (11%) in IVIG group (shingles) versus 2 of 8 (25%) in no or incomplete IVIG group (CMV viremia, recurrent streptococcal pharyngitis).

The use of scheduled IVIG between and after alemtuzumab infusions was associated with fewer autoimmune adverse reactions. Multiple mechanisms likely contribute to the overall therapeutic effect. IVIG neutralizes autoantibodies and can minimize the release of proinflammatory cytokine signaling from T cells to B cells that secrete autoantibodies. Limitations of this observational study include the lack of randomization, small sample size and varying doses of IVIG.
Authors/Disclosures
Edith Graham, MD (Northwestern University)
PRESENTER 		Dr. Graham has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Graham has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG Therapeutics. The institution of Dr. Graham has received research support from F. Hoffman-La Roche Ltd. The institution of Dr. Graham has received research support from Novartis.
Jonathan Datar, MD (Intermountain Health) Dr. Datar has received publishing royalties from a publication relating to health care.
Bruce A. Cohen, MD, FAAN (Northwestern University, Feinberg School of Medicine) Dr. Cohen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bristol Myers Squibb. Dr. Cohen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for EMD Serono. Dr. Cohen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Mylan. The institution of Dr. Cohen has received research support from Genentech. The institution of Dr. Cohen has received research support from MedDay. The institution of Dr. Cohen has received research support from Consortium of Multiple Sclerosis Centers.
Roumen D. Balabanov, MD (Northwestern University) Dr. Balabanov has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Balabanov has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Balabanov has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Balabanov has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen. The institution of Dr. Balabanov has received research support from NextCure. The institution of Dr. Balabanov has received research support from Biogen. The institution of Dr. Balabanov has received research support from NINDS.