Severe meningo-/encephalitis after daclizumab therapy for multiple sclerosis
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Severe meningo-/encephalitis after daclizumab therapy for multiple sclerosis. / Stork, Lidia; Brück, Wolfgang; von Gottberg, Phillip; Pulkowski, Ulrich; Kirsten, Florian; Glatzel, Markus; Rauer, Sebastian; Scheibe, Franziska; Radbruch, Helena; Hammer, Eckhard; Stürner, Klarissa H; Kaulen, Barbara; Heesen, Christoph; Hoffmann, Frank; Brock, Sebastian; Pawlitzki, Marc; Bopp, Tobias; Metz, Imke.
In: MULT SCLER J, Vol. 25, No. 12, 10.2019, p. 1618-1632.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Severe meningo-/encephalitis after daclizumab therapy for multiple sclerosis
AU - Stork, Lidia
AU - Brück, Wolfgang
AU - von Gottberg, Phillip
AU - Pulkowski, Ulrich
AU - Kirsten, Florian
AU - Glatzel, Markus
AU - Rauer, Sebastian
AU - Scheibe, Franziska
AU - Radbruch, Helena
AU - Hammer, Eckhard
AU - Stürner, Klarissa H
AU - Kaulen, Barbara
AU - Heesen, Christoph
AU - Hoffmann, Frank
AU - Brock, Sebastian
AU - Pawlitzki, Marc
AU - Bopp, Tobias
AU - Metz, Imke
PY - 2019/10
Y1 - 2019/10
N2 - BACKGROUND:: Daclizumab is a monoclonal antibody that binds the high-affinity interleukin-2 receptor and was approved for the treatment of relapsing multiple sclerosis. Due to severe inflammatory brain disorders, the approval was suspended in March 2018.OBJECTIVE AND METHODS:: This retrospective cohort study summarizes clinical, laboratory, radiological, and histological findings of seven patients who developed meningo-/encephalitis after daclizumab therapy.RESULTS:: Patients presented with encephalitis and/or meningitis and suffered from systemic symptoms such as fever (5/7), exanthema (5/7), or gastrointestinal symptoms (4/7). Secondary autoimmune diseases developed. Blood analysis revealed an increase in eosinophils (5/7). Six patients fulfilled the diagnostic criteria for a drug reaction with eosinophilia and systemic symptoms (DRESS). Magnetic resonance imaging (MRI) showed multiple contrast-enhancing lesions, and enhancement of the ependyma (6/7), meninges (5/7), cranial or spinal nerves (2/7), and a vasculitic pattern (3/7). Histology revealed a pronounced inflammatory infiltrate consisting of lymphocytes, plasma cells and eosinophils, and densely infiltrated vessels. Most patients showed an insufficient therapeutic response and a high disability at last follow-up (median Expanded Disability Status Scale (EDSS) 8). Two patients died.CONCLUSION:: Meningoencephalitis and DRESS may occur with daclizumab therapy. This potential lethal side effect is characterized by a dysregulated immune response. Our findings underline the importance of postmarketing drug surveillance.
AB - BACKGROUND:: Daclizumab is a monoclonal antibody that binds the high-affinity interleukin-2 receptor and was approved for the treatment of relapsing multiple sclerosis. Due to severe inflammatory brain disorders, the approval was suspended in March 2018.OBJECTIVE AND METHODS:: This retrospective cohort study summarizes clinical, laboratory, radiological, and histological findings of seven patients who developed meningo-/encephalitis after daclizumab therapy.RESULTS:: Patients presented with encephalitis and/or meningitis and suffered from systemic symptoms such as fever (5/7), exanthema (5/7), or gastrointestinal symptoms (4/7). Secondary autoimmune diseases developed. Blood analysis revealed an increase in eosinophils (5/7). Six patients fulfilled the diagnostic criteria for a drug reaction with eosinophilia and systemic symptoms (DRESS). Magnetic resonance imaging (MRI) showed multiple contrast-enhancing lesions, and enhancement of the ependyma (6/7), meninges (5/7), cranial or spinal nerves (2/7), and a vasculitic pattern (3/7). Histology revealed a pronounced inflammatory infiltrate consisting of lymphocytes, plasma cells and eosinophils, and densely infiltrated vessels. Most patients showed an insufficient therapeutic response and a high disability at last follow-up (median Expanded Disability Status Scale (EDSS) 8). Two patients died.CONCLUSION:: Meningoencephalitis and DRESS may occur with daclizumab therapy. This potential lethal side effect is characterized by a dysregulated immune response. Our findings underline the importance of postmarketing drug surveillance.
KW - Journal Article
U2 - 10.1177/1352458518819098
DO - 10.1177/1352458518819098
M3 - SCORING: Journal article
C2 - 30657420
VL - 25
SP - 1618
EP - 1632
JO - MULT SCLER J
JF - MULT SCLER J
SN - 1352-4585
IS - 12
ER -