Effect of B cell depletion therapy

Graves’ disease (GD) affects 1 – 2% of the adult female population and 25 – 50% of individuals with GD develop Graves’ orbitopathy (GO). GO, independent of thyroid status, has a significant impact upon patients’ quality of life and, in the most severe cases, can result in permanent sight loss due to optic nerve damage.     

Glucocorticoids are the mainstay of treatment for active moderate to severe GO. Approximately,  20% of individuals with severe and active GO have no improvement, or only a partial response, to high-dose glucocorticoids. These patients remain a challenge for clinicians managing GO.

Rituximab (RTX) is a therapeutic monoclonal antibody, which targets the CD-20 transmembrane protein expressed on the surface of B lymphocytes. In preliminary studies, the results of RTX for GO have been promising.

Mitchell et al report the effect of RTX on 9 patients with glucocorticoid-resistant GO. Results show that there was a significant reduction in thyrotropin receptor binding inhibitory immunoglobulin levels in all patients following RTX treatment and a reduction in the clinical activity score was seen in all cases. They also report striking improvement in pretibial thyroid dermopathy in one patient following RTX.

The authors conclude that RTX may be a useful therapeutic option in individuals with active GO, as it appears to be well tolerated, safe, clinically effective and cost-efficient.

Read the full article at Mitchell et al (2013) Clinical Endocrinology 79; 437-422; DOI: 10.1111/cen.12141.