Successful Corticosteroid-Sparing Effect of Rituximab in the Treatment of Refractory Idiopathic Orbital Inflammatory Disease

Shao, Eh; Karydis, Andreas; Gemenetzi, M; Taylor, Simon

doi:10.1159/000356523

Cited by 4 publications

(1 citation statement)

References 7 publications

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“…Information regarding adverse events was available for 38 (38.4%) of patients. The most common complication was infusion related exacerbation of orbital disease (3/38, 7.9%) that resolved with systemic corticosteroids; all affected patients later experienced remission of orbital inflammation [ 47 , 48 , 51 ]. One case each (1/38, 2.6%) of de novo hepatitis [ 24 ], nausea [ 18 ], and adenovirus pneumonitis that resulted in death [ 15 ] was also described.…”

Section: Results (Tables 1 2 )mentioning

confidence: 99%

Rituximab for treatment of non-infectious and non-malignant orbital inflammatory disease

Cunningham

2021

J Ophthal Inflamm Infect

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Purpose To provide a comprehensive review of rituximab use for the treatment of non-infectious/non-malignant orbital inflammation. Methods Review of literature through January 2021. Results Individual data was available for 167 patients with refractory non-infectious/non-malignant orbital inflammation who received treatment with rituximab (RTX). Rituximab was generally utilized as third-line or later treatment (108/149, 72.5%) at a mean of 44.6 months following the diagnosis of orbital inflammation (range = 0 to 360 months; median = 13.7 months). Patients with non-infectious/non-malignant orbital inflammation either received prior treatment with corticosteroids only (27/122, 22.1%), or with one (31/122, 25.4%), two (25/122, 20.5%), or three or more (25/122, 20.5%) corticosteroid-sparing immunosuppressive agents with or without corticosteroids before initiation of RTX treatment. The rheumatologic protocol (two infusions of 1 gram of RTX separated by 14 days) was utilized most frequently (80/144, 55.6%), followed by the oncologic protocol (four weekly infusions of 375 mg/m2 RTX; 51/144, 35.4%). Various other off-label regimens were used infrequently (13/144, 9.0%). Rituximab treatments resulted in a positive therapeutic response for the majority of patients with orbital inflammation (146/166, 88.0%). Commonly treated diagnoses included granulomatosis with polyangiitis (99/167, 59.3%), IgG-4 related disease (36/167, 21.6%), and orbital inflammation of indeterminate cause (25/167, 15.0%). No side effects were reported in 83.3% (55/66) of cases. The most common RTX-induced adverse event was an infusion-related temporary exacerbation of orbital disease (4/66, 6.1%), which occurred prior to the routine use of systemic corticosteroids as pre-conditioning. Conclusions Overall, RTX appears to be both efficacious and well-tolerated as second- or third-line therapy for patients with non-infectious/non-malignant orbital inflammation.

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