The development of new autoimmune disorders (ADs) may occur following immune reconstitution therapy (IRT) for multiple sclerosis (MS), according to recent research from Vilnius University Hospital Santaros Klinikos. The study analyzed data from 179 patients treated between 2014 and 2023, focusing on the emergence of ADs after different IRT regimens, namely autologous haematopoietic stem cell transplantation (AHSCT), alemtuzumab (ALE), and cladribine (CLA).
Immune reconstitution therapy is known for its efficacy in managing relapsing forms of MS, with the potential to induce long-term remission. The necessity for this study arose over concerns about the risk of secondary autoimmune diseases which may manifest post-treatment. By reviewing patient outcomes, researchers sought to elucidate the prevalence and nature of these new disorders.
The findings revealed notable differences among the treatment protocols: 16.2% of patients treated with AHSCT, 42.1% who received ALE, and just 1.6% of those on CLA developed new ADs. "Neurologists should be attentive to the development of secondary ADs after ALE and AHSCT in MS patients," the authors emphasized.
Among the autoimmune conditions observed, thyroid disorders were the most prevalent; out of those diagnosed, 81.3% were classified as thyroid-related. The study highlights the alarming fact, noting, "The majority of ADs after IRT were of thyroid origin, and significant thyroid eye disease requiring operative intervention was diagnosed in one patient." This is concerning, considering the historical prevalence of thyroid dysfunction associated with these therapeutic regimens.
Prior research focused mainly on haematopoietic stem cell transplants for blood cancers, but the current study offers insight specific to MS patients treated with IRT, underscoring the need for detailed post-therapy monitoring. The occurrence of thyroid dysfunction, particularly following ALE, mirrors findings from previous studies, affirming the necessity of guidelines for follow-up care.
Over the study duration, patients received varying follow-up periods, averaging 61.1 months for those treated with ALE, which was higher than typical follow-up periods, often resulting in similar rates of ADs observed during the second and third years after treatment.
The research indicates substantial differences between the treatment modalities. AHSCT and ALE not only had higher AD rates compared to CLA, but the onset of these conditions varied significantly, with ALE showing the earliest diagnosis post-therapy. Most thyroid disorders developed within the first five years, emphasizing the need for vigilance within this time frame.
The study concluded with strong recommendations for clinicians, citing, "The occurrence of thyroid dysfunction after the second course of ALE was the same as reported in most previous studies." This serves as guidance for monitoring patients effectively after IRT, reinforcing the importance of identifying potentially emergent conditions as soon as feasible.
Overall, the findings highlight the risks associated with immune reconstitution strategies for managing relapsing multiple sclerosis and necessitate comprehensive, long-term follow-up monitoring to mitigate the development of secondary autoimmune disorders.
