![]() ![]() A recent publication on the 4–5-year long follow-up of 61 highly active MS patients reports one patient with “total alopecia” after alemtuzumab ( 9). ![]() However, few reports account alopecia as an autoimmune event caused by alemtuzumab infusion. FDA’s label 2 does not mention alopecia as relevant adverse event. Nevertheless, alemtuzumab’s EMA label 1 refers to alopecia as a common side effect in 1–10 people. Regarding to the risk of alopecia during alemtuzumab treatment, both pivotal trials CARE-MS I and CARE-MS II did not report alopecia as a common adverse event ( 1, 2). The patient provided written informed consent for publication of his case history and images. Regrowth of hair did not occur for a follow-up period of 6 months. All laboratory tests including thyroid hormones and thyroid antibodies, as well as total blood count, revealed no abnormalities throughout the disease course. However, the patient abstained from further therapies. Alopecia totalis was diagnosed and steroid treatment discussed. A few thin and pigmented residual hairs, around 3 cm long, were remaining on the scalp. During dermatological reassessment, the patient presented with non-scarring alopecia including scalp, chest, both thighs, axillae, and pubic region. Three months later, the patient complained of progression of alopecia to a patchy body hair loss and complete loss of all scalp hair including eyebrows and eyelashes (Figures 1C–E). Consultation of a dermatologist resulted in the diagnosis alopecia areata (AA) based on the classical clinical presentation. He denied having had similar symptoms before. ![]() Six months after the second cycle, the patient reported newly emerged smooth, circular areas of complete hair loss at both thighs (Figure 1B). Since initiation of alemtuzumab treatment, MS-disease activity remained stable with an expanded disability status scale of 4.0. Medical history excluded any other autoimmune disease besides RRMS. Prior to alemtuzumab treatment, the patient received interferon-beta-Ia i.m., interferon-beta-Ib s.c., and 11 cycles of mitoxantrone with a cumulative dose of 71 mg/m 2 without relevant hair loss (Figure 1A). Case ReportĪ 49-year-old Caucasian man received two cycles of alemtuzumab for his RRMS. Here we provide evidence, that alopecia is an additional, but barely recognized secondary autoimmune disease after alemtuzumab application. Though alopecia is also described in alemtuzumab-treated patients the mechanisms of hair loss have not been discussed in current literature. The pathobiology of this chemotherapy induced hair-loss is well known ( 8). In addition, autoimmune renal diseases are observed at a lower frequency but may require renal transplantation.Īlopecia is a common adverse event in several MS treatment options such as teriflunomide or mitoxantrone. Most commonly, thyroid disorders (35–41%) and immune thombocytopenia occur (3–3.5%) ( 4– 7). According to several published long-term treatment data, around 47% of the patients develop another autoimmune disorder apart from MS. The most significant adverse event relies to autoimmunity secondary to alemtuzumab application. Alemtuzumab has proven superior efficacy over interferon beta 1a ( 1– 3). It is a highly effective agent for the treatment of relapsing-remitting multiple sclerosis (RRMS). We emphasize the necessity of careful clinical surveillance of alemtuzumab-treated patients for yet undescribed autoimmune diseases.Īlemtuzumab is a monoclonal antibody targeting the CD52 surface antigen, thereby depleting all mature lymphocytes. Here, we report a little-noticed autoimmune disease affecting the skin, very likely being associated with alemtuzumab. Current literature rarely connects alemtuzumab with the onset of alopecia of autoimmune origin. Within 3 months, AA progressed to complete loss of all body hair (alopecia universalis). The patient was diagnosed as having alopecia areata (AA). We report a case of a patient with relapsing-remitting multiple sclerosis who reported smooth, circular areas of complete hair loss on both thighs 6 months after the second treatment cycle with alemtuzumab. Secondary autoimmunity is the most frequent adverse event occurring in almost every other alemtuzumab-treated multiple sclerosis patient. 2Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany.1Department of Neurology, Universitätsklinikum Bonn, Bonn, Germany. ![]()
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