title: Rapid response to and long-term effectiveness of anti-CD20 antibody in conventional therapy resistant Graves' orbitopathy: A five-year follow-up study.
abstract: Abstract The aim of this investigations was to study the effectiveness of anti-CD20 antibody therapy in Graves' orbitopathy (GO) resistant to glucocorticoids. Five patients were entered in the study. The protocol required no improvement of orbital status after a recent course of glucocorticoids. Activity of GO was confirmed by three independent techniques: clinical activity score (CAS), (99m)Tc-labeled diethylene triamine pentaacetic acid ((99m)Tc DTPA) single photon emission computed tomography and magnetic resonance imaging. Rituximab (RTX) was given as weekly infusions of 375 mg/m(2) body surface area for four weeks. The mean follow-up period was 67 (range 58-81) months. Improvement of GO has been observed in all patients: CAS before therapy was 6.5 ± 1.7 and decreased to 3.4 ± 1.6 by one month (p < 0.05) and remained unchanged (3.2 ± 1.7) at 12 months. No further CAS change, in either direction, was detected during the yearly follow-up visits. The mean DTPA uptake before therapy was 16.52 ± 4.51 MBq/cm(3) and decreased to 11.97 ± 2.36 MBq/cm(3) at one year (p < 0.002). The mean of T2 relaxation times before and one year after therapy were 96.91 ± 17.61 ms and 84.29 ± 9.41 ms, respectively (p < 0.001). The mean serum TSH receptor antibody (TRAb) levels before therapy, at the one month and one year control visits were 7.4 ± 3.4 U/L, 5.6 ± 4.5 U/L and 1.7 ± 1.5 U/L, respectively (p < 0.004). No correlation between changes of TRAb and activity parameters has been found. Anti-CD20 treatment seems to influence positively the clinical course of GO, and this effect seems to be stable for five years. To our knowledge, this is the longest published follow-up of RTX treatment in GO.
authors.affiliation: Division of Endocrinology, Insitute of Medicine, University of Debrecen , Debrecen , Hungary .
authors.forename: Annamaria
authors.initials: A
authors.lastname: Erdei
authors.forename: Gyorgy
authors.initials: G
authors.lastname: Paragh
authors.forename: Peter
authors.initials: P
authors.lastname: Kovacs
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Karanyi
authors.forename: Ervin
authors.initials: E
authors.lastname: Berenyi
authors.forename: Laszlo
authors.initials: L
authors.lastname: Galuska
authors.forename: Agota
authors.initials: A
authors.lastname: Lenkey
authors.forename: Lajos
authors.initials: L
authors.lastname: Szabados
authors.forename: Ferenc
authors.initials: F
authors.lastname: Gyory
authors.forename: Bernadett
authors.initials: B
authors.lastname: Ujhelyi
authors.forename: Andras
authors.initials: A
authors.lastname: Berta
authors.forename: Judit
authors.initials: J
authors.lastname: Boda
authors.forename: Eszter
authors.initials: E
authors.lastname: Berta
authors.forename: Miklos
authors.initials: M
authors.lastname: Bodor
authors.forename: Annamaria
authors.initials: A
authors.lastname: Gazdag
authors.forename: Endre V
authors.initials: EV
authors.lastname: Nagy
mesh_terms: D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D049970:Graves Ophthalmopathy / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D018828:Immunoglobulins, Thyroid-Stimulating / Q000097:blood; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D000069283:Rituximab; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood; D015899:Tomography, Emission-Computed, Single-Photon; D014284:Triiodothyronine / Q000097:blood
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D018828:Immunoglobulins, Thyroid-Stimulating; D007166:Immunosuppressive Agents; C094372:thyrotropin-binding inhibitory immunoglobulin; D014284:Triiodothyronine; D000069283:Rituximab; D013972:Thyrotropin; D013974:Thyroxine
keywords: Biological treatment; Graves’disease; endocrine orbitopathy; hyperthyroidism; thyroid