Immune‐Mediated Hepatitis Induced by Therapy With Alemtuzumab in a Patient With Multiple Sclerosis

Bolte, Ashley C.; Schmidt, Hartmut; Schlevogt, Bernhard

doi:10.1002/hep.31435

Cited by 5 publications

(1 citation statement)

References 5 publications

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“…According to the events reported post-marketing by the drug manufacturer, autoimmune hepatitis is a rare event, with an incidence of 10.7/10,000 patients treated with alemtuzumab [ 171 , 172 ]. Two cases of alemtuzumab-induced acute liver failure have been reported in the literature; the first one was a patient with immune-mediated hepatitis requiring long-term immunosuppressive therapy, the other a patient with classic autoimmune hepatitis [ 173 , 174 ]. Another case of fatal autoimmune hepatitis, probably alemtuzumab-related, was reported in the EudraVigilance database (Table 3 ) [ 175 ].…”

Section: Disease-modifying Therapiesmentioning

confidence: 99%

The Disease-Modifying Therapies of Relapsing-Remitting Multiple Sclerosis and Liver Injury: A Narrative Review

et al. 2021

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In this narrative review, we analyze pre-registration and post-marketing data concerning hepatotoxicity of all disease-modifying therapies (DMTs) available for the treatment of relapsing-remitting multiple sclerosis, including beta interferon, glatiramer acetate, fingolimod, teriflunomide, dimethyl fumarate, cladribine, natalizumab, alemtuzumab, and ocrelizumab. We review the proposed causal mechanisms described in the literature and we also address issues like use of DMTs in patients with viral hepatitis or liver cirrhosis. Most data emerged in the post-marketing phase by reports to national pharmacovigilance agencies and published case reports or case series. Serious liver adverse events are rare, but exact incidence is largely unknown, as are predictive factors. Unfortunately, none of the DMTs currently available for the treatment of multiple sclerosis is free of potential hepatic toxic effects. Cases of acute liver failure have been reported for beta-interferon, fingolimod, natalizumab, alemtuzumab, and ocrelizumab by different mechanisms (idiosyncratic reaction, autoimmune hepatitis, or viral reactivation). Patients with multiple sclerosis should be informed about possible hepatic side effects of their treatment. Most cases of liver injury are idiosyncratic and unpredictable. The specific monitoring schedule for each DMT has been reviewed and the clinician should be ready to recognize clinical symptoms suggestive for liver injury. Not all DMTs are indicated in cirrhotic patients. For some DMTs, screening for hepatitis B virus and hepatitis C virus is required before starting treatment and a monitoring or antiviral prophylaxis schedule has been established. Beta interferon, glatiramer acetate, natalizumab, and alemtuzumab are relatively contraindicated in autoimmune hepatitis due to the risk of disease exacerbation.

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Section: Disease-modifying Therapiesmentioning

confidence: 99%

The Disease-Modifying Therapies of Relapsing-Remitting Multiple Sclerosis and Liver Injury: A Narrative Review

et al. 2021

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Autoimmune liver disease and multiple sclerosis: state of the art and future perspectives

et al. 2023

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Clinical observations suggest that the prevalence of autoimmune diseases is changing over time. Both autoimmune liver diseases and multiple sclerosis have shown a significant increase in the last decades. Although the coexistence of autoimmune diseases within individuals and families is a common phenomenon, the extent to which liver disease and multiple sclerosis co-occur is not clear. Case reports and few studies have reported the possible coexistence of multiple sclerosis with thyroid diseases, inflammatory bowel disease, psoriasis, and rheumatoid arthritis. It is unknown whether there is a definite association between multiple sclerosis and autoimmune liver diseases. We reviewed the literature to summarize the available studies on the association between different autoimmune liver diseases (autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis) and treated or untreated multiple sclerosis.

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From Multiple Sclerosis to Organ-Specific Autoimmune Disorders: Insights into the Molecular and Clinical Implications of Comorbidity

Zabihi,

Zangooie,

Piroozkhah

et al. 2024

Mol Neurobiol

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Immune‐Mediated Hepatitis Induced by Therapy With Alemtuzumab in a Patient With Multiple Sclerosis

Cited by 5 publications

References 5 publications

The Disease-Modifying Therapies of Relapsing-Remitting Multiple Sclerosis and Liver Injury: A Narrative Review

The Disease-Modifying Therapies of Relapsing-Remitting Multiple Sclerosis and Liver Injury: A Narrative Review

Autoimmune liver disease and multiple sclerosis: state of the art and future perspectives

From Multiple Sclerosis to Organ-Specific Autoimmune Disorders: Insights into the Molecular and Clinical Implications of Comorbidity

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