Efficacy of rituximab treatment for thyroid-associated ophthalmopathy as a result of intraorbital B-cell depletion in one patient unresponsive to steroid immunosuppression.
One patient with Graves' hyperthyroidism and ophthalmopathy in its active phase and unresponsive to steroid, was treated with the anti-CD20 monoclonal antibody, rituximab (RTX), as part of an open study. The effect of RTX in the thyroid and the orbital tissues was studied. The ophthalmopathy responded to RTX therapy by ameliorating the eye signs with a decrease in the clinical activity score from 5 to 2 in 3 months, while the patient had peripheral B-cell depletion. Hyperthyroidism did not improve during the 6 months of B-cell depletion and serum TSH-receptor antibodies (TRAb) levels did not significantly change after RTX therapy. Therefore, the patient underwent total thyroidectomy and few B-cells were found in the thyroid tissue specimens. While the patient eye disease remained stable (clinical activity score = 2), we performed corrective orbital decompression and we found absence of lymphocytes in the orbital tissue specimens. We believe that RTX treatment in Graves' disease may cause amelioration of ophthalmopathy by depleting total lymphocytes population in the orbit. The persistence of Graves' hyperthyroidism suggests that a single cycle of RTX does not result in complete lymphocyte depletion in thyroid tissue and thus no decline in serum TRAb was observed.
Institutes of Endocrine Sciences, University of Milan, Fondazione Ospedale Policlinico IRCCS, Italy.
Mario
M
Salvi
Guia
G
Vannucchi
Irene
I
Campi
Stefania
S
Rossi
Paola
P
Bonara
Francesco
F
Sbrozzi
Claudio
C
Guastella
Sabrina
S
Avignone
Giacinta
G
Pirola
Roberto
R
Ratiglia
Paolo
P
Beck-Peccoz
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D001323:Autoantibodies / Q000097:blood; D001402:B-Lymphocytes / Q000276:immunology* / Q000473:pathology; D005260:Female; D006111:Graves Disease / Q000097:blood / Q000473:pathology / Q000601:surgery; D049970:Graves Ophthalmopathy / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D006801:Humans; D018828:Immunoglobulins, Thyroid-Stimulating; D007150:Immunohistochemistry; D007155:Immunologic Factors / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D018655:Lymphocyte Count; D016131:Lymphocyte Subsets; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D009915:Orbit / Q000276:immunology* / Q000473:pathology; D011989:Receptors, Thyrotropin / Q000097:blood; D000069283:Rituximab; D013601:T-Lymphocytes / Q000473:pathology; D013965:Thyroidectomy; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D001323:Autoantibodies; D018828:Immunoglobulins, Thyroid-Stimulating; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D011989:Receptors, Thyrotropin; C056626:thyroid microsomal antibodies; C094372:thyrotropin-binding inhibitory immunoglobulin; D000069283:Rituximab; D013972:Thyrotropin; D013974:Thyroxine; D008775:Methylprednisolone