Treatment of Active Corticosteroid-Resistant Graves’ Orbitopathy

Pérez-Moreiras, J.V.; Álvarez-López, Alejandro; Gómez, Estanislao Cardiel

doi:10.1097/iop.0000000000000037

Cited by 162 publications

(135 citation statements)

References 22 publications

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“…An IL-6 receptor antagonist, tocilizumab has been successfully employed in rheumatic disease (103) and recently in an open clinical trial on 18 patients with GO refractory to GC treatment (104). Disease activity improved in all patients, proptosis values decreased in 72%, and ocular motility improved in 83%.…”

Section: Targeting Cytokines/chemokines With Monoclonal Antibodiesmentioning

confidence: 99%

THERAPY OF ENDOCRINE DISEASE: Endocrine dilemma: management of Graves’ orbitopathy

Campi

Vannucchi

Salvi

2016

European Journal of Endocrinology

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Management of Graves' orbitopathy (GO) must be based on the correct assessment of activity and severity of the disease. Activity is usually assessed with the Clinical Activity Score, whereas severity is classified according to a European Group On Graves' Orbitopathy (EUGOGO) consensus statement as mild, moderate-to-severe, and sight-threatening. Myopathic and chronic congestive forms are uncommon clinical presentations of GO. Restoration and maintenance of stable euthyroidism are recommended in the presence of GO. In moderate-to-severe disease, steroids have been widely employed and have shown to possess an anti-inflammatory activity, but about 20 -30% of patients are not responsive and present recurrence. Some novel immunosuppressors have already been employed in clinical studies and have shown interesting results, although the lack of randomized and controlled trials suggests caution for their use in clinical practice. Potential targets for therapy in GO are the thyroid-stimulating hormone and the insulin-like growth factor 1 receptor on the fibroblasts, inflammatory cytokines, B and T cells, and the PIK3/mTORC1 signaling cascades for adipogenesis. A recent open study has shown that tocilizumab, an anti-sIL-6R antibody, inactivates GO. Consistent reports on the efficacy of rituximab have recently been challenged by randomized controlled trials. As the main goal of treatment is the well-being of the patient, the therapeutic strategy should be addressed to better suit the patient needs, more than improving one or more biological parameters. The increasing availability of new therapies will expand the therapeutic options for GO patients and allow the clinician to really personalize the treatment to better suit the patients' personal needs.

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Section: Targeting Cytokines/chemokines With Monoclonal Antibodiesmentioning

confidence: 99%

THERAPY OF ENDOCRINE DISEASE: Endocrine dilemma: management of Graves’ orbitopathy

Campi

Vannucchi

Salvi

2016

European Journal of Endocrinology

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“…Efficacy and safety of administration of these drugs in pediatric patients is still unclear. In adults, effects of therapy seem promising [56][57][58], but further trials are needed.…”

Section: Management Of Thyroid-associated Ophthalmopathy In Children mentioning

confidence: 99%

An update on thyroid-associated ophthalmopathy in children and adolescents

Szczapa-Jagustyn¹,

Gotz‐Więckowska²,

Kocięcki³

2016

Journal of Pediatric Endocrinology and Metabolism

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“…Randomized clinical trials have been published, either defining optimization of old treatments, such as high-dose GCs, or proposing novel biological treatments, such as rituximab. Other ongoing studies are evaluating the efficacy (and safety) of immunosuppressants, such as mycophenolate, or biologics, such as tocilizumab [134] or anti-IGF-1 receptor monoclonal antibody. Recommendations about the role of these novel agents will have to await the results of large randomized controlled studies.…”

Section: Perspectives and Conclusionmentioning

confidence: 99%

The 2016 European Thyroid Association/European Group on Graves' Orbitopathy Guidelines for the Management of Graves' Orbitopathy

et al. 2016

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Graves' orbitopathy (GO) is the main extrathyroidal manifestation of Graves' disease, though severe forms are rare. Management of GO is often suboptimal, largely because available treatments do not target pathogenic mechanisms of the disease. Treatment should rely on a thorough assessment of the activity and severity of GO and its impact on the patient's quality of life. Local measures (artificial tears, ointments and dark glasses) and control of risk factors for progression (smoking and thyroid dysfunction) are recommended for all patients. In mild GO, a watchful strategy is usually sufficient, but a 6-month course of selenium supplementation is effective in improving mild manifestations and preventing progression to more severe forms. High-dose glucocorticoids (GCs), preferably via the intravenous route, are the first line of treatment for moderate-to-severe and active GO. The optimal cumulative dose appears to be 4.5-5 g of methylprednisolone, but higher doses (up to 8 g) can be used for more severe forms. Shared decision-making is recommended for selecting second-line treatments, including a second course of intravenous GCs, oral GCs combined with orbital radiotherapy or cyclosporine, rituximab or watchful waiting. Rehabilitative treatment (orbital decompression surgery, squint surgery or eyelid surgery) is needed in the majority of patients when GO has been conservatively managed and inactivated by immunosuppressive treatment.

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Treatment of Active Corticosteroid-Resistant Graves’ Orbitopathy

Abstract: This study suggests that intravenous Tocilizumab may be effective on reducing activity in patients with thyroid eye disease refractory to intravenous steroids.

Cited by 162 publications

References 22 publications

THERAPY OF ENDOCRINE DISEASE: Endocrine dilemma: management of Graves’ orbitopathy

THERAPY OF ENDOCRINE DISEASE: Endocrine dilemma: management of Graves’ orbitopathy

An update on thyroid-associated ophthalmopathy in children and adolescents

The 2016 European Thyroid Association/European Group on Graves' Orbitopathy Guidelines for the Management of Graves' Orbitopathy

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