open access

Vol 68, No 5 (2017)
Original paper
Published online: 2017-06-14
Submitted: 2016-10-06
Accepted: 2016-11-07
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Clinical and immunological changes in patients with active moderate-to-severe Graves’ 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
·
Pubmed: 28660988
·
Endokrynologia Polska 2017;68(5):498-504.

open access

Vol 68, No 5 (2017)
Original Paper
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 Graves' 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-dose of rituximab on 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 Graves' 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-dose of rituximab on 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.

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Keywords

Graves' 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 Graves’ orbitopathy treated with very low-dose rituximab

Journal

Endokrynologia Polska

Issue

Vol 68, No 5 (2017)

Article type

Original paper

Pages

498-504

Published online

2017-06-14

DOI

10.5603/EP.a2017.0040

Pubmed

28660988

Bibliographic record

Endokrynologia Polska 2017;68(5):498-504.

Keywords

Graves' orbitopathy
rituximab
clinical activity score
thyroid gland
dysthyroid optic neuropathy

Authors

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

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