Clinical efficacy of combined rituximab treatment in a woman with severe Graves' ophthalmopathy

Abstract

Abstract. The present study reports the case of a female Chinese patient with Graves' disease (GD) and severe Graves' ophthalmopathy (GO) in its active phase, who was treated with propylthiouracil and oral prednisolone for 2 months at a local hospital. However, a lack of improvement in symptoms meant that the patient was transferred to the First Affiliated Hospital of Xi'an Jiaotong University (Xi'an, China), whereupon the patient received high-dose intravenous methylprednisolone pulse therapy, although with limited efficacy. Subsequently, rituximab (RTX; anti-CD20 monoclonal antibody) combined with orbital irradiation treatment was initiated. The patient responded positively to the combined treatment; the clinical symptoms and enlargement of the extraocular muscles were ameliorated, and there were marked decreases in the clinical activity and NOSPECS grading scores. Furthermore, the serum levels of anti-thyrotropin receptor antibodies (TRAb) were markedly decreased at 2 months following RTX therapy. The patient was maintained in a euthyroid state by treatment with methimazole during and following RTX therapy. It was concluded that RTX treatment may attenuate severe GO by depleting lymphocytes, and may promote the recovery of GD by reducing the serum levels of TRAb.

The effects of Rituximab on Graves’orbitopathy: A retrospective study of 14 patients

“…Its immunosuppressive actions are mediated by three mechanisms: reduced activity of B cells as antigen-presenting cells, decreased production of inflammatory cytokines and potential blockage of pathogenic autoantibody generation. 3,6,7 Approved for clinical use in rheumatoid arthritis (RA) and non-Hodgkin's lymphoma, the potential efficacy of RTX has been investigated since 2006 through several uncontrolled studies [7][8][9][10][11][12][13][14][15][16][17][18][19] , and it was assumed that it might become an effective option even as a first-line treatment for GO. 20 In February 2015, two randomised controlled studies, both focused on clinical activity score (CAS), showed contradictory conclusions regarding the efficacy of RTX.…”

Monoclonal Antibodies for the Treatment of Graves Orbitopathy: Precision Medicine?

“…1 shows that 76 articles of the 954 screened records were included in the review. 25–101 The literature on the use of Mabs for treating GO has been centered on blockage of IL-6 (Tocilizumab), 34,39,41,49,50,53,56,58–60,63,64,68–72,79,80,84,87,90,96–98 anti-CD20 lymphocytes (Rituximab), 26–33,35,37,38,40,42–48,51,54,55,61,62,65,67,73,89 and IGF1R (Teprotumumab). 52,66,74–78,82,85,86,88,91,92,94,95,99–101 Three articles have described Mabs that block TNF-α, 25,36,83 and one article has described Mabs that block the B-lymphocyte stimulator (BLyS) protein (Belimumab).…”

“…1 shows that 76 articles of the 954 screened records were included in the review. The literature on the use of Mabs for treating GO has been centered on blockage of IL-6 (Tocilizumab), 34,39,41,49,50,53,56,[58][59][60]63,64,[68][69][70][71][72]79,80,84,87,90,[96][97][98] anti-CD20 lymphocytes (Rituximab), [26][27][28][29][30][31][32][33]35,37,38,40,[42][43][44][45][46][47][48]51,54,55,61,62,65,…”

“…52,66 Various adverse effects have been reported for the three most tested Mabs (Table 6). In several case reports and case series, there was no collateral effects 31,32,38,39,45,46,48,51,53,60,64,87,88 or they were not stated. 27,40,50,56,[69][70][71]73,76,78,86,90,95,100,102 Some collateral effects depended on the drug that was being used (Table 6).…”