Development of acquired haemophilia A in a patient treated with alemtuzumab for multiple sclerosis

Madeley, Jarrett; Hodges, Georgina; Birchley, Andrew

doi:10.1136/bcr-2018-226588

Cited by 10 publications

(9 citation statements)

References 15 publications

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“…1 Acquired haemophilia A due to secondary autoimmune disease related to alemtuzumab treatment has been reported previously in four patients treated for multiple sclerosis and one treated for anti-neutrophil cytoplasmic antibodies-associated vasculitis. [2][3][4][5][6] Here, we report two further cases of acquired haemophilia A after alemtuzumab treatment with comparatively milder symptoms at presentation.…”

Section: Introductionmentioning

confidence: 75%

Two case reports of acquired haemophilia A as complications of alemtuzumab treatment for multiple sclerosis

2021

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ObjectiveTo describe the case histories of two patients who developed acquired haemophilia A following treatment with alemtuzumab for multiple sclerosis.ResultsTwo patients, a 48-year-old woman and a 31-year-old woman, developed acquired haemophilia A 21 months after their second doses of alemtuzumab. Both presented with spontaneous bruising, and the second case reported menorrhagia. One patient required treatment to control bleeding. Both patients responded to treatment with prednisolone and cyclophosphamide to eliminate the inhibitor.ConclusionsAcquired haemophilia A is a rare complication following treatment with alemtuzumab. Activated partial thromboplastin time and prothrombin time should be performed in cases of abnormal bleeding in which the platelet count is normal, to facilitate timely diagnosis and prevention of major bleeding complications.

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Section: Introductionmentioning

confidence: 75%

Two case reports of acquired haemophilia A as complications of alemtuzumab treatment for multiple sclerosis

2021

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“…The indication for alemtuzumab was multiple sclerosis in three cases 7‐10 and antineutrophil cytoplasmic antibody‐associated vasculitis in one case 11 . The interval between alemtuzumab therapy and the diagnosis of AHA ranged from 11 months 9,10 to 5 years 8,11 . Depletion of regulatory T cells, natural killer and dendritic cells and escape of auto‐reactive B cells after alemtuzumab therapy have been proposed to contribute to the increased susceptibility of secondary autoimmunity 1 .…”

Section: Parameter Patient 1 Patient 2 Reference Rangementioning

confidence: 99%

“…[3][4][5] In our patients, additional investigations, including auto-immune serology In literature, an association between alemtuzumab and AHA has been described in four other patients. [7][8][9][10][11] The indication for alemtuzumab was multiple sclerosis in three cases [7][8][9][10] and antineutrophil cytoplasmic antibody-associated vasculitis in one case. 11 The interval between alemtuzumab therapy and the diagnosis of AHA ranged from 11 months 9,10 to 5 years.…”

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Acquired haemophilia A after alemtuzumab therapy

et al. 2020

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Treatment with alemtuzumab leads to a prolonged depletion of T-and B cells, natural killer cells, dendritic cells and monocytes. 1 Alemtuzumab therapy is associated with secondary auto-immune disorders, including auto-immune thyroid disease, immune thrombocytopenia and inflammatory neuropathy. 1 Here, two patients with acquired haemophilia A (AHA) are described who were previously treated with alemtuzumab.

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“…AHA is extremely rare in patients treated with AI (0.2% in clinical trials) 94. For bleeding, both the platelet count and the routine coagulations test (prothrombin time) and active partial thromboplastin time) should be included in the laboratory serological monitoring95,96 madeley of patients treated with AI.…”

Section: “Surprises” In the Repertoire Of Unwanted Secondary Autoimmumentioning

confidence: 99%

<p>Vitamin D supplementation for the prevention or depletion of side effects of therapy with alemtuzumab in multiple sclerosis</p>

Goischke¹

2019

TCRM

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Purpose of review: Not only the multiple sclerosis specialist but also the general neurologist and primary care practitioner are increasingly aware of possible adverse events (AEs) by treatment with alemtuzumab (over 47% risk of secondary autoimmune-mediated diseases). Vitamin D supplementation's effect (VDS) to reduce these autoimmune AEs is poorly performed in routine practice. This article seeks to justify why this simple, inexpensive, patient-friendly therapy should be seriously discussed. Recent findings: Patients who have developed autoimmunity also show a high basal level of IL-21, a cytokine which increases the growth of auto-reactive T-cells. For side effects such as thyroid dysfunction, autoimmune thrombocytopenia, autoimmune hemolytic anemia, autoimmune hepatitis, diabetes mellitus type 1, and alopecia areata/alopecia totalis, VDS may have an impact on the immunological mechanism, in particular lowering levels of IL-17 and IL-21. Summary: The potential role of vitamin D in influencing autoimmune diseases is evident. If a life-threatening side-effect can be prevented by high-dose VDS, it is ethical to initiate this add-on therapy despite contradictory results in studies on the effectiveness of VDS.

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Development of acquired haemophilia A in a patient treated with alemtuzumab for multiple sclerosis

Cited by 10 publications

References 15 publications

Two case reports of acquired haemophilia A as complications of alemtuzumab treatment for multiple sclerosis

Two case reports of acquired haemophilia A as complications of alemtuzumab treatment for multiple sclerosis

Acquired haemophilia A after alemtuzumab therapy

<p>Vitamin D supplementation for the prevention or depletion of side effects of therapy with alemtuzumab in multiple sclerosis</p>

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