Novel treatment modalities for Graves' orbitopathy.
Non-surgical treatments for moderate to severe and active Graves' orbitopathy (systemic glucocorticoids with or without orbital radiotherapy) have limited effects on the underlying autoimmune process causing the disease. Although the clinical responses to treatment are often good, at least one third of patients with Graves' orbitopathy are eventually dissatisfied with the treatment outcome. Progress in our understanding of the autoimmune basis of Graves' orbitopathy (although still incomplete) made it possible, similar to other autoimmune disorders, to envision the use of novel immunomodulating drugs. Among the currently available biologic agents, the CD20+ B cell-depleting agent, rituximab, and tumor necrosis factor-alpha inhibitors are presently the drugs that have the best chance of being employed in the future for the treatment of Graves' orbitopathy. However, randomized, controlled clinical trials to support their use are warranted.
Bartalena
Luigi
L
Departments of Clinical Medicine and Surgical Sciences, University of Insubria, Division of Endocrinology, Varese, Italy. luigi.bartalena@uninsubria.it
Lai
Adriana
A
Sassi
Lorenza
L
Lombardi
Valentina
V
Dalle Mule
Ilaria
I
Gandolfo
Myriam
M
Liparulo
Luigi
L
Azzolini
Claudio
C
Piantanida
Eliana
E
Tanda
Maria Laura
ML
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D049970:Graves Ophthalmopathy / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D015282:Octreotide / Q000627:therapeutic use*; D010456:Peptides, Cyclic / Q000627:therapeutic use; D013004:Somatostatin / Q000031:analogs & derivatives / Q000627:therapeutic use; D045162:Thiazolidinediones / Q000627:therapeutic use*
D000911:Antibodies, Monoclonal; D018931:Antineoplastic Agents, Hormonal; D007155:Immunologic Factors; D010456:Peptides, Cyclic; D045162:Thiazolidinediones; C060347:lanreotide; D013004:Somatostatin; D015282:Octreotide