"Rituximab"- new hope for Thyroid Eye Disease and Graves' Ophtalmophaty

“Rituximab appears to have a significant effect on thyroid eye disease that requires further randomized controlled studies”- this is what says a recent study about a new drug called Rituximab. Is Rituximab the new HOPE?

The information below is taken from a recently publishes clinical study of the following authors:

 Silkiss RZ, Reier A, Coleman M, Lauer SA. Rituximab for Thyroid Eye Disease.Ophthal Plast Reconstr Surg 2010.DOI: 10.1097/IOP.0b013e3181c4dfde

 Rituximab is an intravenously administered chimeric mouse-human monoclonal antibody that targets the CD20 antigen on pre-B and mature B lymphocytes. Hematopoietic stem cells, pro-B cells and normal plasma cells do not express the CD20 antigen, thus Rituximab does not induce significant immunosuppression. The Food and Drug Administration approved Rituximab in 1997 for the treatment of B-cell non-Hodgkin lymphoma, and in 2006 it was approved for the treatment of rheumatoid arthritis and is now being studied as a possible treatment for a number of other autoimmune diseases. Limited information has suggested that Rituximab results in B cell depletion in the thyroid gland of patients with Graves’ disease, and a study of the decline in production of specific thyroid stimulating autoantibodies has been reported.

 RESULTS

The mean age of the 12 patients that entered into the study was 52.1 years (range 34 to 80), 5 (41.7%) were men and 7 (58.3%) were women, 7 (58.3%) were white, 5 (41.7%) were Hispanic, 4 (33%) were smokers, 1 (8%) had unilateral and 11 (91.7%) had bilateral orbitopathy. Hyperthyroidism was present for 1 year or less in 7 patients, 2 to3 years in 2 patients, and 4 years in 1 patient, and 1 was euthyroid. Seven were treated with oral thyroid suppression (propylthiouracil, methimazole, or Cytomel, and 2 patients did not require treatment for hyperthyroidism, and none had pretibial myxedema.

Twelve patients with active TED were treated with 2 courses of rituximab over a 2-week period, and there were no adverse effects of the rituximab infusions and no reported side effects during the 1-year post infusion observation period.

 CONCLUSION

Twelve patients with active TED were treated with 2 courses of Rituximab over a 2-week period. There were no adverse effects of the Rituximab infusions and no reported side effects during 1year after the infusion of the drug. There was a significant improvement in CAS scores that was observed 1 month after infusion of Rituximab that was sustained throughout the 12-month observation period.

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