Treatment of Graves' disease with rituximab specifically reduces the production of thyroid stimulating autoantibodies

Fassi, Daniel El; Banga, J. Paul; Gilbert, Jeffrey M.; Padoa, Carolyn J.; Hegedűs, László; Nielsen, Claus Henrik

doi:10.1016/j.clim.2008.09.007

Cited by 82 publications

(74 citation statements)

References 32 publications

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“…The patient under study showed no infusion reactions, such as fever, hypotension, tachycardia, and pruritus, after the first or the second dose of RTX. Although serum IgM level decreased from 108 mg/dL (measured before RTX treatment) to 63 mg/dL measured at 9 months after the completion of treatment (Table 2), as reported in previous studies [22], these levels recovered. There were no marked changes in the serum levels of IgG and IgA, and no infections were detected.…”

Section: Fig 2 Time Course Of Thyroid Datasupporting

confidence: 83%

Induction of thyroid remission using rituximab in a patient with type 3 autoimmune polyglandular syndrome including Graves’ disease and type 1 diabetes mellitus: A case report

et al. 2015

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Section: Fig 2 Time Course Of Thyroid Datasupporting

confidence: 83%

Induction of thyroid remission using rituximab in a patient with type 3 autoimmune polyglandular syndrome including Graves’ disease and type 1 diabetes mellitus: A case report

et al. 2015

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“…To date, clinical studies have shown that RTX can be employed in patients with active moderate-to-severe GO either as first-line treatment or when IVMP therapy fails (114,115,116,117,118,119).…”

Section: Rituximabmentioning

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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“…Decrease of TSH-R antibodies after RTX has been reported inconsistently in uncontrolled studies (6). It has been suggested in one study that the subpopulation of TSH-R-stimulating antibodies are affected by B cell depletion (8), thereby inducing stable remission of hyperthyroidism, but this finding has not been confirmed in patients treated for active GO (9). Alternatively, RTX has been shown to interfere with the production of inflammatory cytokines and with B cell-driven antigen presentation (7), suggesting that RTX might be indirectly responsible for the depletion of autoreactive T cells also.…”

Section: Introductionmentioning

confidence: 99%

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

Stan

Salvi

2017

European Journal of Endocrinology

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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.

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Treatment of Graves' disease with rituximab specifically reduces the production of thyroid stimulating autoantibodies

Cited by 82 publications

References 32 publications

Induction of thyroid remission using rituximab in a patient with type 3 autoimmune polyglandular syndrome including Graves’ disease and type 1 diabetes mellitus: A case report

Induction of thyroid remission using rituximab in a patient with type 3 autoimmune polyglandular syndrome including Graves’ disease and type 1 diabetes mellitus: A case report

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

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

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Treatment of Graves' disease with rituximab specifically reduces the production of thyroid stimulating autoantibodies

Cited by 82 publications

References 32 publications

Induction of thyroid remission using rituximab in a patient with type 3 autoimmune polyglandular syndrome including Graves&rsquo; disease and type 1 diabetes mellitus: A case report

Induction of thyroid remission using rituximab in a patient with type 3 autoimmune polyglandular syndrome including Graves&rsquo; disease and type 1 diabetes mellitus: A case report

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

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

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Induction of thyroid remission using rituximab in a patient with type 3 autoimmune polyglandular syndrome including Graves’ disease and type 1 diabetes mellitus: A case report

Induction of thyroid remission using rituximab in a patient with type 3 autoimmune polyglandular syndrome including Graves’ disease and type 1 diabetes mellitus: A case report