title: Induction of thyroid remission using rituximab in a patient with type 3 autoimmune polyglandular syndrome including Graves' disease and type 1 diabetes mellitus: a case report.
abstract: Rituximab (RTX) is a monoclonal antibody that targets the B-cell-specific CD20 antigen. Recent reports indicate that RTX is effective against type 1 diabetes mellitus (T1DM) and hematologic as well as autoimmune diseases. Other studies have indicated that RTX therapy leads to the remission of recurrent or active Graves' disease (GD). However, the efficacy of RTX in Japanese patients with autoimmune polyglandular syndrome (APS) has not been reported to date. Herein, we report the case of a patient with GD and T1DM with sustained endogenous insulin secretion capacity. To protect pancreatic β cells, we administered RTX at a dose of 500 mg (approximately 300 mg/m2) on 2 occasions 1 week apart. After treatment, no adverse effects were observed, and thyroid stimulating hormone receptor antibody (TRAb) was no longer detectable 4 months after RTX administration. In addition, the reduction in TRAb level improved thyroid function. Notably, the treatment induced remission over a period of 1 year after the diagnosis of GD.
authors.affiliation: First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Kurozumi
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Okada
authors.forename: Tadashi
authors.initials: T
authors.lastname: Arao
authors.forename: Manabu
authors.initials: M
authors.lastname: Narisawa
authors.forename: Keiichi
authors.initials: K
authors.lastname: Torimoto
authors.forename: Sunao
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D018951:Antigens, CD20 / Q000737:chemistry; D001323:Autoantibodies / Q000032:analysis / Q000737:chemistry; D003922:Diabetes Mellitus, Type 1 / Q000209:etiology / Q000517:prevention & control*; D006111:Graves Disease / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects / Q000627:therapeutic use*; D007564:Japan; D008297:Male; D016884:Polyendocrinopathies, Autoimmune / Q000188:drug therapy* / Q000208:ethnology / Q000276:immunology / Q000503:physiopathology; D011989:Receptors, Thyrotropin / Q000037:antagonists & inhibitors; D012074:Remission Induction; D000069283:Rituximab / Q000009:adverse effects / Q000627:therapeutic use*; D013961:Thyroid Gland / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology
chemical_list: D018951:Antigens, CD20; D001323:Autoantibodies; D007155:Immunologic Factors; D011989:Receptors, Thyrotropin; D000069283:Rituximab