Die Post-Alemtuzumab-Therapie-induzierte Schilddrüsendysfunktion bei schubförmig-remittierender MS (RRMS) – ein variantenreiches Krankheitsbild auf einem interdisziplinären Terrain

Zusammenfassung

Alemtuzumab-induzierte Schilddrüsendysfunktionen (engl.: Alemtuzumab-induced thyroid dysfunction; AITD) können die Lebensqualität von MS-Patienten wesentlich beeinträchtigen, wenn diese Nebenwirkung nicht rechtzeitig erkannt und adäquat von allen Fachrichtungen reagiert wird. Vor Alemtuzumab-Therapie sollten der TSH-Spiegel und die Schilddrüsen-AK untersucht werden. Bei Nachweis von TPO-AK vor Beginn der Behandlung betrug das Risiko 69 %, eine AITD zu entwickeln im Vergleich zu TPO-negativen Patienten mit nur 31 %.

Trotzdem waren 85 %, die eine AITD später entwickelten, vor Therapie TPO-AK-negativ, sodass AK-Negativität basal kein Schutz vor AITD darstellt. Deshalb müssen die periodischen Tests streng durchgeführt werden. Eine interdisziplinäre Zusammenarbeit von Neurologen, Internisten (Endokrinologen) und Gynäkologen führt zum rechtzeitigen Erkennen des variantenreichen klinischen Verlaufes bei wechselnden biochemischen Befunden mit entsprechenden diagnostischen und therapeutischen Konsequenzen. Da die klinischen Symptome der Hypothyreose/Hyperthyreose sich mit denen der MS überschneiden können, ist die Bestimmung von laborchemischen Parametern auch im Verlauf rechtzeitig unerlässlich, insbesondere bei graviden Patientinnen. Durch die kostengünstige und gut verträgliche Add-on-Therapie mit Vitamin D mit multiplen Zielwirkungen – 1. auf die AITD, 2. auf die Reduktion der Krankheitsaktivität und 3. auf die positive Beeinflussung einer Gravidität (Verringerung einer niedrigen Geburtsgewichts-, Eklampsie- und Frühgeburtenrate, Reduktion der Übertragung der MS auf die Nachkommenschaft) – sollte trotz noch offener Fragen den Betroffenen die Chance zur Minderung der Progression nicht verwehrt werden. Der Arzt spielt eine wichtige Rolle in der Stärkung der Fähigkeit der Patienten, ihre eigene Krankheit zu managen, um die Krankheitsprogression zu vermindern. Im Arzt-Patienten-Gespräch sollte die Reduzierung von Risikofaktoren (z.B. Vit.-D-Mangel) thematisiert werden. Ein Engagement für ein optimales interdisziplinäres Management mit Therapieindividualisierung und Reduzierung von Arzneimittelnebenwirkungen verbessert die Lebensqualität von MS-Patienten.

Abstract

Alemtuzumab-induced thyroid dysfunction (AITD) can significantly affect the quality of life of MS patients if this side effect is not recognized in time and adequately responded to by all specialist disciplines. Before alemtuzumab therapy, the TSH level and the thyroid gland should be examined. In the detection of TPO-AK before the start of treatment, the risk of developing an AITD was 69 % compared to TPO-negative patients with only 31 % risk. 85 %, of patients who developed AITD later were TPO-AK-negative before therapy, so that baseline AK-negativity is no protection from AITD. Therefore, periodic tests must be carried out strictly. An interdisciplinary collaboration between neurologists, internists (endocrinologists) and gynecologists leads to the timely recognition of the varied clinical course with varying biochemical findings with corresponding diagnostic and therapeutic consequences. Since the clinical symptoms of hypothyroidism/hyperthyroidism can overlap with those of MS, determination of laboratory chemical parameters is also essential over time, especially in the case of pregnant patients. Through the cost-effective and well-tolerated add-on therapy with vitamin D with multiple targets – 1. AITD, 2. reduction of disease activity and 3. positive influence on pregnancy (reduction of low birth weight, eclampsia and premature birth rate, reduction of transmission of MS to the offspring), the chances of reducing progression should not be denied to those affected. The physician has an important role in strengthening the ability of patients to shape and manage their own illness and to influence disease progression. Acceptance of reduction of risk factors (vitamin D deficiency) by patients can undoubtedly be achieved during physician-patient conversation. A commitment to optimal interdisciplinary management with therapy individualization and reduction of drug side effects improves the quality of life of MS patients.

Schlüsselwörter

Alemtuzumab - Nebenwirkungen - Vitamin-D-Therapie - Schilddrüsendysfunktion - Gravidität

Keywords

Alemtuzumab - adverse effects - vitamin D therapy - thyroid dysfunction - pregnancy

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