Orbital B-Lymphocyte Depletion in a Treatment Failure of Rituximab for Thyroid Eye Disease

Gess, Adam J.; Silkiss, Rona Z.

doi:10.1097/iop.0b013e31828956a8

Cited by 14 publications

(11 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One case report has demonstrated B-cell depletion from the blood and orbital fat of a TED patient treated with rituximab who still went on to require orbital decompression for worsening disease [18]. A separate, prospective, randomized, double-blinded, placebo-controlled trial compared treatment with two rituximab infusions versus two saline infusions, given 2 weeks apart, in 21 patients with TED.…”

Section: Key Pointsmentioning

confidence: 95%

Current trends in the management of thyroid eye disease

Rao

MacIntosh

Yoon

et al. 2015

Current Opinion in Ophthalmology

View full text Add to dashboard Cite

show abstract

Section: Key Pointsmentioning

confidence: 95%

Current trends in the management of thyroid eye disease

Rao

MacIntosh

Yoon

et al. 2015

Current Opinion in Ophthalmology

View full text Add to dashboard Cite

show abstract

“…Failure of RTX was reported in one patient whose GO progressed to acute DON (21) and in one who already had DON (22) and failed to improve on RTX despite achieving peripheral B cell depletion. On the other hand, another ten patients with DON reviewed in the paper by Salvi et al (6) have responded to RTX with improvement of their visual sight.…”

Section: Rituximab In Go: Pretrial Experiencementioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Rituximab therapy for Graves’ orbitopathy – lessons from randomized control trials

Stan

Salvi

2017

European Journal of Endocrinology

View full text Add to dashboard Cite

Rituximab (RTX) use in open-label series has been associated with very encouraging responses in patients with active and moderate-to-severe Graves' orbitopathy (GO). Recently, randomized controlled trials of RTX have been performed in such patients to answer the question of clinical efficacy and the safety profile of this agent. That data, reported separately, focused on Clinical Activity Score (CAS) and indicated in one trial a strong benefit of RTX in comparison with IV glucocorticoids, whereas the other trial noted the absence of a benefit by comparison with placebo. The outcome was reanalyzed post hoc here, using EUGOGO criteria, and the results were not significantly different. The authors comment further on the differences between the two trials regarding populations treated, methodology, analysis of outcomes and the adverse effect profile of RTX. The populations treated appear different with younger patients, lower TRAb and shorter duration of disease prevalent in the Italian trial, all elements favoring a better response. Smoking, usually diminishing a response, was also more prevalent in some patients. The combined outcome proposed by EUGOGO revealed similar results with CAS regarding RTX efficacy; yet, it might be a more comprehensive outcome. The adverse events of concern relate mainly to the risk of DON, which seems to be increased by the use of RTX in a certain subset of patients. Based on available data, a multicenter trial using the EUGOGO-proposed outcomes might be the next best step to define the role of RTX in GO therapy.

show abstract

“…Rituximab induces cell apoptosis by binding to the CD20 membrane antigen in both normal and malignant B cells (12). In addition, it significantly depletes lymphocytes not only in the blood but also in the target tissue, and the effect remained significant 2 months after rituximab infusion (13). Based on the pharmacological mechanism of rituximab, clinical trials on autoimmune diseases have indicated the potential use of rituximab as a candidate treatment for autoimmune diseases (14).…”

Section: Discussionmentioning

confidence: 99%

Use of Rituximab After Orbital Decompression Surgery in Two Grave’s Ophthalmopathy Patients Progressing to Optic Neuropathy

Zhang

et al. 2020

Front. Endocrinol.

View full text Add to dashboard Cite

Background: While orbital decompression can alleviate optic nerve compression and prevent further vision loss in dysthyroid optic neuropathy (DON), it cannot relieve inflammatory symptoms. Very high doses of intravenous glucocorticoids (GCs) are the first-line therapy for DON; however, the effective rate is only 40% and might be much lower in patients who fail high-dose GC pulse therapy and progressed to DON. The results of two case series studies indicated that rituximab treatment had a much better curative effect compared to very high doses of intravenous GCs, but some patients required urgent orbital decompression after rituximab injection because rituximab might lead to the release of cytokines, aggravated intraorbital edema, and further vision loss. Methods: We retrospectively studied the therapeutic process of two Grave's ophthalmopathy (GO) patients complicated with DON who failed high-dose GC pulse therapy and underwent orbital decompression. Both patients received single-dose (500 mg) rituximab treatment. Results: During more than 2 years of follow-up, rituximab treatment exhibited significant improvement in inflammatory symptoms, as manifested by a substantial decrease in Clinical Activity Score (CAS); meanwhile, the vision of both patients improved significantly and their diplopia was relieved. Conclusions: The results of this study were consistent with those of two previous case series studies indicating the significant and lasting effect of rituximab treatment on DON, especially for patients with GC resistance or recurrence after GC therapy. Orbital decompression before rituximab treatment might reduce the incidence of rapid vision loss and urgent orbital decompression surgery caused by aggravated orbital edema after rituximab injection; however, the necessity for preventive decompression surgery requires further study.

show abstract

Orbital B-Lymphocyte Depletion in a Treatment Failure of Rituximab for Thyroid Eye Disease

Cited by 14 publications

References 12 publications

Current trends in the management of thyroid eye disease

Current trends in the management of thyroid eye disease

MANAGEMENT OF ENDOCRINE DISEASE: Rituximab therapy for Graves’ orbitopathy – lessons from randomized control trials

Use of Rituximab After Orbital Decompression Surgery in Two Grave’s Ophthalmopathy Patients Progressing to Optic Neuropathy

Contact Info

Product

Resources

About