open access

Ahead of print
Original papers
Published online: 2017-06-14
Submitted: 2016-10-06
Accepted: 2016-11-07
Get Citation

Clinical and immunological changes in patients with active moderate-to-severe Graves̕ orbitopathy treated with very low-dose rituximab

David Karasek, Lubica Cibickova, Marta Karhanova, Jana Kalitova, Jan Schovanek, Zdenek Frysak
DOI: 10.5603/EP.a2017.0040

open access

Ahead of print
Original papers
Published online: 2017-06-14
Submitted: 2016-10-06
Accepted: 2016-11-07

Abstract

Introduction: Glucocorticoids represent the therapy of choice for active and moderate-to-severe Graves̕ orbitopathy (GO). In some patients, rituximab, a monoclonal antibody against the cluster of differentiation (CD) 20 receptor of B-lymphocytes, can serve as a second-line or an alternative treatment. The effect of very low-doseof rituximabon the clinical activity of GO and corresponding clinical or laboratory changes is reported.

Material and methods: Changes of Clinical Activity Score (CAS) for GO, proptosis, levels of thyroid-stimulating hormone receptor antibodies, and depletion of CD19+ and CD20+ B-lymphocytes were determined in ten patients (two men and eight women) with active moderate-to-severe GO treated with a single 100-mg dose of rituximab. Correlations between differences of clinical and laboratory parameters were performed.

Results: A significant decrease of CAS was found during subsequent examinations compared to the baseline values. A significant depletion of CD19+ and CD20+ B-lymphocytes was detected after rituximab administration. Differences between follow-up and baseline levels of CD20+ positively correlated with differences in CAS after six (p < 0.05) and 12 months (p < 0.01). Differences in CD19+ levels correlated with differences in CAS after 12 months (p < 0.05) of the treatment. Two patients developed dysthyroid optic neuropathy (DON) requiring orbital decompression. No other rituximab side effects were reported during the whole study duration.

Conclusions: A single very low-dose of rituximab appears to be very well tolerated and effective enough to reduce clinical activity in active moderate-to-severe GO patients without impending DON.

Abstract

Introduction: Glucocorticoids represent the therapy of choice for active and moderate-to-severe Graves̕ orbitopathy (GO). In some patients, rituximab, a monoclonal antibody against the cluster of differentiation (CD) 20 receptor of B-lymphocytes, can serve as a second-line or an alternative treatment. The effect of very low-doseof rituximabon the clinical activity of GO and corresponding clinical or laboratory changes is reported.

Material and methods: Changes of Clinical Activity Score (CAS) for GO, proptosis, levels of thyroid-stimulating hormone receptor antibodies, and depletion of CD19+ and CD20+ B-lymphocytes were determined in ten patients (two men and eight women) with active moderate-to-severe GO treated with a single 100-mg dose of rituximab. Correlations between differences of clinical and laboratory parameters were performed.

Results: A significant decrease of CAS was found during subsequent examinations compared to the baseline values. A significant depletion of CD19+ and CD20+ B-lymphocytes was detected after rituximab administration. Differences between follow-up and baseline levels of CD20+ positively correlated with differences in CAS after six (p < 0.05) and 12 months (p < 0.01). Differences in CD19+ levels correlated with differences in CAS after 12 months (p < 0.05) of the treatment. Two patients developed dysthyroid optic neuropathy (DON) requiring orbital decompression. No other rituximab side effects were reported during the whole study duration.

Conclusions: A single very low-dose of rituximab appears to be very well tolerated and effective enough to reduce clinical activity in active moderate-to-severe GO patients without impending DON.

Get Citation

Keywords

Graves̕ orbitopathy; rituximab; clinical activity score; thyroid gland; dysthyroid optic neuropathy

About this article
Title

Clinical and immunological changes in patients with active moderate-to-severe Graves̕ orbitopathy treated with very low-dose rituximab

Journal

Endokrynologia Polska

Issue

Ahead of print

Published online

2017-06-14

DOI

10.5603/EP.a2017.0040

Keywords

Graves̕ orbitopathy
rituximab
clinical activity score
thyroid gland
dysthyroid optic neuropathy

Authors

David Karasek
Lubica Cibickova
Marta Karhanova
Jana Kalitova
Jan Schovanek
Zdenek Frysak

Important: This website uses cookies.tanya dokter More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Via MedicaWydawcą serwisu jest  "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl