title: Rituximab therapy for refractory orbital inflammation: results of a phase 1/2, dose-ranging, randomized clinical trial.
abstract: OBJECTIVE
  Orbital inflammation is a potentially blinding and disfiguring disease process that is often treated with systemic corticosteroids and immunosuppression; better treatments are needed.
  
  
  OBJECTIVE
  To determine whether rituximab, a monoclonal antibody against the B-lymphocyte antigen CD20, is effective in the treatment of refractory orbital inflammation.
  
  
  METHODS
  A dose-ranging, randomized, double-masked phase 1/2 clinical trial was conducted at a tertiary referral ophthalmology clinic. Ten individuals with orbital inflammation refractory to systemic corticosteroids and at least 1 other immunosuppressive agent were enrolled from January 2007 to March 2010.
  
  
  METHODS
  Rituximab infusions were administered on study days 1 and 15 at doses of either 500 mg or 1000 mg. Initial responders with recurrent inflammation after week 24 were permitted reinfusion with an additional cycle of 2 open-label 1000-mg rituximab infusions.
  
  
  METHODS
  The primary outcomes were reduction of inflammation measured with a validated orbital disease grading scale and corticosteroid dose reduction by at least 50%. The secondary outcomes were visual acuity, reduction in pain, and participant- and physician-reported global health assessment.
  
  
  RESULTS
  Of 10 enrolled patients, 7 demonstrated improvement on the orbital disease grading scale at the 24-week end point with rituximab therapy. Of these 7 individuals, 4 were receiving corticosteroids at study inception and all achieved successful dose reduction. For the secondary outcome measures in the 10 participants, 7 patients and 8 patients improved in self-rated and physician global health scores, respectively, and 7 patients had reduction in pain by 25% or more at 24 weeks. Four patients who were positive responders at the week 24 end point experienced breakthrough inflammation after week 24 and received reinfusions between 24 and 48 weeks. Vision remained stable in all participants. Three of 10 patients had short-term objective or subjective worsening 2 to 8 weeks after receiving rituximab infusions, which was averted in subsequent patients with oral corticosteroids administered during the infusion and did not affect the eventual positive treatment outcome. No significant differences with regard to efficacy, toxicity, or likelihood of retreatment were noted between the dosing arms.
  
  
  CONCLUSIONS
  Rituximab was safe and effective in 7 of 10 patients with noninfectious orbital disease, although 4 required reinfusion with rituximab to maintain control of orbital inflammation. Substantial toxicity was not noted. Rituximab should be considered in the treatment of refractory orbital inflammation.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00415506.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Suhler
authors.forename: Lyndell L
authors.initials: LL
authors.lastname: Lim
authors.forename: Robert M
authors.initials: RM
authors.lastname: Beardsley
authors.forename: Tracy R
authors.initials: TR
authors.lastname: Giles
authors.forename: Sirichai
authors.initials: S
authors.lastname: Pasadhika
authors.forename: Shelly T
authors.initials: ST
authors.lastname: Lee
authors.forename: Alexandre
authors.initials: A
authors.lastname: de Saint Sardos
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Butler
authors.forename: Justine R
authors.initials: JR
authors.lastname: Smith
authors.forename: James T
authors.initials: JT
authors.lastname: Rosenbaum
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage*; D018951:Antigens, CD20; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D016727:Orbital Pseudotumor / Q000188:drug therapy* / Q000473:pathology; D012008:Recurrence; D012189:Retrospective Studies; D000069283:Rituximab; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014792:Visual Acuity
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D007155:Immunologic Factors; D000069283:Rituximab