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PTU-031 Drug induced liver injury among patients with multiple sclerosis treated with alemtuzumab- a single-centre experience

Backround and aims Alemtuzumab (Lemtrada ) is a humanized monoclonal anti-CD52 antibody approved for the treatment of patients with relapsing-remitting multiple sclerosis (RRMS). Current information regarding drug induced liver injury (DILI) during treatment is available from small cohorts and case reports. Our aim was investigate the prevalence of DILI among patients with RRMS treated with Alemtuzumab. Methods Retrospective analysis of epidemiological, clinical and laboratory data of all patients with RRMS treated with Alemtuzumab in King’s College Hospital between December 2014 to August 2018. Results 94 RRMS patients received Alemtuzumab. The average age of the patients was 36 years (range 18–55) and most patients were female (71.3%); 56 patients received 2 annual treatment courses. Deranged liver enzymes developed during the 5 days of admission for Alemtuzumab treatment in 25 patients (26.5%). Among them, the average age was 37 (range 18–53) and the majority were female (68%). The pattern of elevated liver enzymes was cholestatic (elevated GGT) in 11 patients, hepatocellular (elevated AST) in 6 patients and mixed in 6 patients. Among 3 patients with elevated bilirubin, 2 involved an isolated increase in bilirubin. The degree of AST elevation was mild (X10ULN) in one patient. Among all patients with available post treatment data liver functions returned to baseline. Patients with markedly elevated liver enzymes did not receive a second course of Alemtuzumab. Among 15 patients that received two annual courses, elevated liver enzymes were observed only during the first course in 7 patients and only during the second course in 4 patients. Four patients received 2 treatment courses, all with a mild degree of liver enzyme elevation. Conclusions Liver enzyme elevation was observed in 26.5% of RRMS patients treated with Alemtuzumab. As the exact mechanism of this form of DILI is not well established, monitoring during Alemtuzumab treatment is important and re-challenging should be decided individually.