Long-term remission of steroid-resistant Graves’ orbitopathy after administration of anti-thymocyte globulin

Świerkot, Maria; Kulawik, Grażyna; Sarnat-Kucharczyk, Monika; Jagoda, Krystyna; Mrukwa–Kominek, Ewa; Chudek, Jerzy

doi:10.5603/ep.a2019.0067

Cited by 9 publications

(10 citation statements)

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“…Systemic intra venous GCS still remain the first line of treatment in patient with TAO although there are attempts to use new treatments like anticytokine drugs or anti-thymocyte globulin administration [60][61][62]. The previous studies have also demonstrated that GCS treatment normalises the levels and activity of redox system parameters, which supports their efficacy in oxidative stress reduction in patients with Graves' disease and active TAO.…”

Section: Discussionmentioning

confidence: 91%

The Effect of Immunosuppression on Selected Antioxidant Parameters in Patients with Graves’ Disease with Active Thyroid-Associated Orbitopathy

Londzin-Olesik

Kos–Kudła

Karpe

et al. 2020

Exp Clin Endocrinol Diabetes

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Background and Study Aims Thyroid-associated orbitopathy, the most common extrathyroidal manifestation of Graves’ disease, is an autoimmune inflammation of orbital soft tissue. We report the study assessing the effect of immunosuppressive treatment with methylprednisolone on selected antioxidant parameters in patients with Graves’ disease with active thyroid-associated orbitopathy. Patients and Methods Activity and serum levels of selected antioxidant parameters as well as lipid peroxidation products were determined in a group of 56 patients with active thyroid-associated orbitopathy at three time-points: at baseline, after the discontinuation of intravenous methylprednisolone treatment and at 3 months after the discontinuation of additional oral methylprednisolone treatment. A control group consisted of 20 healthy age- and sex-matched volunteers. Results We found an increased activity of superoxide dismutase and glutathione peroxidase and increased serum levels of uric acid, malondialdehyde and conjugated dienes, as well as a reduced activity of paraoxonase-1 and reduced serum vitamin C level in the study group at baseline. Systemic intravenous and oral methylprednisolone therapy led to normalization of activity and concentration of the most studied parameters. Conclusion Results of our study confirmed that oxidative stress is one of the factors involved in the pathogenesis of thyroid-associated orbitopathy and the methyloprednisolone treatment is effective in reducing both clinical symptoms and oxidative stress in patients with this disease.

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Section: Discussionmentioning

confidence: 91%

The Effect of Immunosuppression on Selected Antioxidant Parameters in Patients with Graves’ Disease with Active Thyroid-Associated Orbitopathy

Londzin-Olesik

Kos–Kudła

Karpe

et al. 2020

Exp Clin Endocrinol Diabetes

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“…was not previously treated with steroids and received rATG as a part of induction therapy after kidney transplantation. The second one was a part of this study ( 14 ). In our series of cases, improvement in the CAS scale was followed by beneficial changes in functional and structural parameters, regardless of the long-lasting activity of moderate-to-severe GO refractory to intravenously administered glucocorticoids.…”

Section: Discussionmentioning

confidence: 99%

Antithymocyte Globulin as Second-Line Therapy in Graves Orbitopathy—Preliminary Results From a Prospective Single-Center Study

et al. 2022

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ObjectiveManagement of Graves’ orbitopathy remains a challenge. Our previous case report has shown promising results for rabbit antithymocyte globulin (rATG) in the treatment of Graves’ orbitopathy.DesignWe present the response of 7 individuals with active moderate-to-severe steroid-resistant Graves’ orbitopathy to rATG, representing preliminary results from a prospective single-center study.MethodsrATG was administered intravenously at a dose of 0.8–1.0 mg/kg daily (cumulative dose of 150–200 mg). The primary outcome measures at weeks 24 and 48 were ≥2-point reduction in Clinical Activity Score from baseline, a proptosis response, a diplopia response, and improvement of distant best-corrected visual acuity and mean retinal sensitivity. Key secondary outcomes included stabilization of ganglion cell complex thickness, a decrease of retinal nerve fiber layer in OCT, and a reduction in CD4/CD8 ratio and TRAb at 48 weeks.ResultsAn improvement in clinical activity score was observed in all patients, with disease inactivation in 3 cases. Proptosis reduction equal to or greater than 2 mm was noted for 8 of 10 eyes. Diplopia improved in three of 6 patients. There was an improvement in best-corrected visual acuity (from 0.69 to 0.78) and mean retinal sensitivity (from 20.8 to 23.5 dB). In addition, there was a long-lasting improvement in CD4/CD8 ratio in 6 patients. Two patients experienced adverse events (influenza and serum sickness).ConclusionrATG therapy offers a long-lasting improvement in moderate-to-severe steroid-resistant Graves’ orbitopathy with improvement in functional vision (reduction of diplopia, improvement of visual acuity, retinal sensitivity, and VEP pattern). The therapy is well-tolerated.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT05199103.

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“…Systemic corticosteroids remain the first line of treatment in patients with TAO, although new methods of treatment are being tried such as biological drugs or anti-thymocyte globulin administration [51][52][53]. Previous studies have also demonstrated that corticosteroid treatment normalises the levels and activity of redox system parameters, which supports their efficacy in oxidative stress reduction in patients with GD and active TAO [33].…”

Section: Original Papermentioning

confidence: 94%

The effect of thyroid hormone status on selected antioxidant parameters in patients with Graves’ disease and active thyroid-associated orbitopathy

Londzin-Olesik

Kos–Kudła

Nowak

et al. 2020

Endokrynologia Polska

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Introduction: Oxidative stress has been implicated in the pathogenesis of thyroid-associated orbitopathy (TAO) in patients with Graves' disease (GD). This study assessed the effect of thyroid hormone abnormalities on selected antioxidant parameters in patients with active TAO. Material and methods:The study group consisted of 56 patients with GD and active TAO treated with antithyroid medication. Depending on the thyroid hormone level, they were subdivided into two groups: Group 1 -hyperthyroid patients (n = 34) and Group 2 -euthyroid patients (n = 22). The total oxidant status expressed as the ferric reducing ability of plasma (FRAP) as well as selected enzymatic and nonenzymatic components of the antioxidant system, including the activity of superoxide dismutase (SOD), glutathione peroxidase (GPx), and paraoxonase 1 (PON-1), as well as the levels of vitamin C, uric acid, and lipid peroxidation products: malondialdehyde (MDA) and conjugated dienes (CD) were assessed in all enrolled participants. Results: The FRAP values in Group 1 were significantly higher than in controls. The FRAP values in Group 2 were lower than in Group 1 and higher than in controls. However, the differences were not significant. In Group 1, the activity of SOD and GPx, as well as serum levels of uric acid, MDA, and CD, were significantly higher than in controls. At the same time, serum PON-1 activity and vitamin C levels were significantly lower in Group 1 than in controls. In Group 2, the SOD activity as well as MDA and CD levels were non-significantly lower than in Group 1 and non-significantly higher than in controls. The activity of GPx in euthyroid patients with TAO was significantly higher than in controls. Conclusions: Hyperthyroidism is a significant contributor to oxidative stress in patients with active TAO, which manifests as upregulated lipid peroxidation and antioxidant system activation. Euthyroid state restoration leads to a relative reduction in activity and levels of most studied antioxidant parameters, which still remain above the normal values. The autoimmune inflammation of the orbital tissue seems to be a thyroid hormone status-independent modifier of oxidative stress.

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Long-term remission of steroid-resistant Graves’ orbitopathy after administration of anti-thymocyte globulin

Cited by 9 publications

References 0 publications

The Effect of Immunosuppression on Selected Antioxidant Parameters in Patients with Graves’ Disease with Active Thyroid-Associated Orbitopathy

The Effect of Immunosuppression on Selected Antioxidant Parameters in Patients with Graves’ Disease with Active Thyroid-Associated Orbitopathy

Antithymocyte Globulin as Second-Line Therapy in Graves Orbitopathy—Preliminary Results From a Prospective Single-Center Study

The effect of thyroid hormone status on selected antioxidant parameters in patients with Graves’ disease and active thyroid-associated orbitopathy

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