Pulsed monoclonal antibody treatment and autoimmune thyroid disease in multiple sclerosis
Abstract
Background Multiple sclerosis results from T-cell-dependent inflammatory demyelination of the central nervous system. Our objective was long-term suppression of inflammation with short-term monoclonal antibody treatment.Methods We depleted 95% of circulating lymphocytes in 27 patients with multiple sclerosis by means of a 5-day pulse of the humanised anti-CD52 monoclonal antibody, Campath-1H. Clinical and haematological consequences of T-cell depletion, and in-vitro responses of patients' peripheral-blood mononuclear cells were analysed serially for 18 months after treatment.Findings Radiological and clinical markers of disease activity were significantly decreased for at least 18 months after treatment. However, a third of patients developed antibodies against the thyrotropin receptor and carbimazole-responsive autoimmune hyperthyroidism. The depleted peripheral lymphocyte pool was reconstituted with cells that had decreased mitogen-induced proliferation and interferon gamma secretion in vitro.Interpretation Campath-1H causes the immune response to change from the Th1 phenotype, suppressing multiple sclerosis disease activity, but permitting the generation of antibody-mediated thyroid autoimmunity.
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In the studies that have reported treatment for alemtuzumab-induced Graves' disease, most patients responded to antithyroid drugs (ATDs), at least initially.
“In the studies that have, most patients responded to antithyroid drugs (ATDs) [1214, 50, 77], at least initially.”
From 2019 European Thyroid Association Guidelines on the Management of Thyroid Dysfunction following Immune Reconstitution Therapy (2019) · cites this paper as [50]
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- Authors
- Coles, A. J., Wing, M., Smith, S., Coraddu, F., Greer, S., Taylor, C., Weetman, A., Hale, G., Chatterjee, V. K., Waldmann, H., & Compston, A.
- Affiliations
- University of Cambridge (GB)
- Addenbrooke's Hospital (GB)
- University of Sheffield (GB)
- University of Oxford (GB)
- Corresponding author
- Coles, Alasdair J
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 1999-11
- Volume
- 354
- Issue
- 9191
- Pages
- 1691-1695
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2112044962
- Cited by
- 453
- References
- 19
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 5 · 2023: 5 · 2022: 5 · 2021: 4 · 2020: 13 · 2019: 14 · 2018: 15 · 2017: 11 · 2016: 17 · 2015: 10 · 2014: 16 · 2013: 26 · 2012: 12
- FWCI
- 8.47
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Medical Research Council
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
- Life Sciences › Immunology and Microbiology › Immunology › T-cell and B-cell Immunology
- Life Sciences › Immunology and Microbiology › Immunology › Psoriasis: Treatment and Pathogenesis
- Keywords
- multiple sclerosis, Campath-1H, anti-CD52 monoclonal antibody, lymphocyte depletion, autoimmune thyroid disease, TSH receptor antibodies, autoimmune hyperthyroidism, T cell depletion, Th1 response, interferon-gamma, lymphocyte proliferation, disease activity
- MeSH terms
- CD52 Antigen, Alemtuzumab, Adult, Antibodies, Monoclonal, Antibodies, Neoplasm, Antigens, Neoplasm, Drug Administration Schedule, Female, Follow-Up Studies, Glycoproteins, Graves Disease, Humans, Lymphocyte Activation, Male, Methylprednisolone, Thyroiditis, Autoimmune, Antigens, CD, CD4 Antigens, B-Lymphocyte Subsets, T-Lymphocyte Subsets, Receptors, Tumor Necrosis Factor, Th1 Cells, Antirheumatic Agents, Multiple Sclerosis, Chronic Progressive, Pulse Therapy, Drug, Antibodies, Monoclonal, Humanized
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