Acute Thrombotic Microangiopathy and Cortical Necrosis Following Administration of Alemtuzumab: A Case Report

Liou, Ashley; Skiver, Brent M.; Yates, Eric; Persad, Paul; Meyer, David; Farland, Andrew M.; Rocco, Michael V.

doi:10.1053/j.ajkd.2018.09.013

Cited by 6 publications

(7 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another case of thrombotic microangiopathy has been reported, but slightly different, with renal involvement and cortical necrosis, requiring haemodialysis, occurring a very short time after the administration (4 h) and with an ADAMTS13 normal activity (57%). 15 This case represents, to our knowledge, the first fully described case of TTP occurring after alemtuzumab treatment in multiple sclerosis. A causal link may allegedly be supposed; however, it remains uncertain.…”

Section: Discussionmentioning

confidence: 64%

Alemtuzumab‐induced immune‐mediated thrombotic thrombocytopenic purpura: A newly described drug‐related autoimmune disease

Bourdin,

Fossé,

Lambotte

et al. 2023

Br J Haematol

View full text Add to dashboard Cite

SummaryImmune‐mediated thrombotic thrombocytopenic purpura (iTTP) is a rare and life‐threatening disease that may result from drug exposure. We report a case of iTTP occurring in a 39‐year‐old patient, 45 months following introduction of the anti‐CD52 lymphoid cell depleting monoclonal antibody alemtuzumab, to treat a relapsing‐remitting multiple sclerosis. Treatment consisted in plasma exchange, corticosteroids and caplacizumab, allowing clinical remission 3 months after the diagnosis, attested by the absence of thrombocytopenia and recovery of ADAMTS‐13 activity. As other autoimmune disorders, iTTP may occur following alemtuzumab. This diagnosis should be suspected in patients with features of thrombotic microangiopathy following this treatment.

show abstract

Section: Discussionmentioning

confidence: 64%

Alemtuzumab‐induced immune‐mediated thrombotic thrombocytopenic purpura: A newly described drug‐related autoimmune disease

Bourdin,

Fossé,

Lambotte

et al. 2023

Br J Haematol

View full text Add to dashboard Cite

show abstract

“…Administration of alemtuzumab was known to rarely cause severe renal adverse effects (76). Nevertheless, in that case report the causal relationship of alemtuzumab with TMA is supported by the fact that (a) symptoms started immediately after the first infusion and (b) the patient did not respond to plasma exchange (9). Another DMT, fingolimod was linked with TMA in an induced-malignant hypertension animal model; in contrast with control group in which fingolimod was not administrated (77).…”

Section: Neurologymentioning

confidence: 89%

“…Some examples of drugs in which antibody mediated DITMA has been confirmed with identification of drug-dependent antibodies to platelets or other cells as the pathophysiologic mechanism of TMA are quinine, oxaliplatin, and vancomycin (12). On the other hand, the dose-dependent and cumulative toxicity model seems to fit for opana's abuse, bevacizumab, levofloxacin, alemtuzumab, and interferon's cases of DITMA (9,(13)(14)(15). It is important to exclude any other diagnosis before attributing TMA to a drug.…”

Section: Mechanisms Of Actionmentioning

confidence: 99%

“…Recently, alemtuzumab; which was approved by US Food and Drug Administration (FDA) for treatment of relapsing-remitting MS (RRMS) at 2014; was associated for the first time with DITMA (8,9). Administration of alemtuzumab was known to rarely cause severe renal adverse effects (76).…”

Section: Neurologymentioning

confidence: 99%

“…Drug-induced thrombotic microangiopathy (DITMA) is a life-threatening complication that is often under-recognized and under-reported (1). Despite recent systematic reviews published in 2015 (2) and 2018 (3), the list of drugs implicated in TMA continues to expand (4)(5)(6)(7)(8)(9). In addition, novel reports have unraveled potential new mechanisms that might contribute to a targeted therapy of this syndrome.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

An Update in Drug-Induced Thrombotic Microangiopathy

et al. 2020

View full text Add to dashboard Cite

Development of a novel tool for individual treatment trials in mucopolysaccharidosis

Wiesinger,

Bigger,

Giugliani

et al. 2024

J of Inher Metab Disea

View full text Add to dashboard Cite

Mucopolysaccharidosis (MPS) encompasses a group of genetic lysosomal storage disorders, linked to reduced life expectancy and a significant lack of effective treatment options. Immunomodulatory drugs could have the potential to be a relevant medical approach, as the accumulation of undegraded substances initiates an innate immune response, which leads to inflammation and clinical deterioration. However, immunomodulators are not licensed for this indication. Consequently, we aim to provide evidence advocating fast access to innovative individual treatment trials (ITTs) with immunomodulatory drugs and high‐quality evaluation of drug effects by implementing a risk–benefit model tailored for MPS. The iterative methodology of our novel decision analysis framework (DAF) involves three key steps: (i) literature review on promising treatment targets and immunomodulators in MPS; (ii) quantitative risk–benefit assessment (RBA) of selected molecules; (iii) assigning phenotypic profiles and quantitative evaluations. The results facilitate a personalized application of the model and are based on published evidence as well as interdisciplinary experts' consensus and patient perspectives. Four promising immunomodulators have been identified: adalimumab, abatacept, anakinra, and cladribine. An improvement in mobility is most likely with adalimumab, while anakinra is anticipated as a treatment of choice for neuronopathic MPS patients. Nevertheless, a comprehensive RBA should always be completed on an individual basis. Our evidence‐based DAF tool for ITTs directly addresses the substantial unmet medical need in MPS and characterizes an initial stride toward precision medicine with immunomodulators.

show abstract

Acute Thrombotic Microangiopathy and Cortical Necrosis Following Administration of Alemtuzumab: A Case Report

Cited by 6 publications

References 16 publications

Alemtuzumab‐induced immune‐mediated thrombotic thrombocytopenic purpura: A newly described drug‐related autoimmune disease

Alemtuzumab‐induced immune‐mediated thrombotic thrombocytopenic purpura: A newly described drug‐related autoimmune disease

An Update in Drug-Induced Thrombotic Microangiopathy

Development of a novel tool for individual treatment trials in mucopolysaccharidosis

Contact Info

Product

Resources

About