title: Treatment by rituximab on six Grave's ophthalmopathies resistant to corticosteroids.
abstract: OBJECTIVE
  Graves' ophthalmopathy occurs in 50% of Graves' disease cases. Treatment is based on smoking cessation, and control of the euthyroidism and ocular repercussions associated with the disease. The active orbital forms are treated with glucocorticoids. Non-validated therapies have also been recently tested. Rituximab has been effectively used several times to treat corticosteroid-resistant Graves' ophthalmopathy associated with an optic neuropathy, but its use could be proposed only in inflammatory ophthalmopathies after failure of the corticosteroids. We present six cases treated since early 2012 at the University Hospital Center of Tours, France.
  
  
  METHODS
  Six patients were treated at the University Hospital Center of Tours, France, between September 2012 and April 2014. The patients had a Mourits' score greater than three after treatment with corticosteroids and/or a severe NOSPECS score and/or orbital inflammation resistant to maximal treatment with intravenous injections of methylprednisolone and an optic neuropathy. They twice received one gram of rituximab by slow intravenous injection two weeks apart. Efficacy was assessed by a decrease of the orbital inflammatory clinical Mourits' score, and visual acuity and visual field testing.
  
  
  RESULTS
  The inflammatory score of patients improved and treatment helped to stop the progression of the sequelae due to neuropathy. The orbital inflammatory clinical score, and the visual acuity and visual field improved but orbital decompression was necessary to complete the treatment.
  
  
  CONCLUSIONS
  Rituximab has been used for the treatment of active corticosteroid-resistant Graves' ophthalmopathies. We also had positive results on patients with visual threat and optic neuropathy, when combined with surgical decompression.
authors.affiliation: Service d'ophtalmologie, hôpital Bretonneau, centre hospitalier universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Faculté de médecine de Tours, 10, boulevard Tonnellé, BP 3223, 37032 Tours cedex 1, France. Electronic address: Flavien.precausta@univ-tours.fr.
authors.forename: Flavien
authors.initials: F
authors.lastname: Précausta
authors.affiliation: Service d'ophtalmologie, hôpital Bretonneau, centre hospitalier universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Arsène
authors.affiliation: Service de médecine interne, hôpital Bretonneau, centre hospitalier universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France.
authors.forename: Peggy
authors.initials: P
authors.lastname: Renoult-Pierre
authors.affiliation: Service de chirurgie maxillofaciale, avenue de la République, centre hospitalier universitaire de Tours, hôpital Trousseau, 37170 Chambray-lès-Tours, France; Faculté de médecine de Tours, 10, boulevard Tonnellé, BP 3223, 37032 Tours cedex 1, France.
authors.forename: Boris
authors.initials: B
authors.lastname: Laure
authors.affiliation: Service de médecine interne, hôpital Bretonneau, centre hospitalier universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France.
authors.forename: Lise
authors.initials: L
authors.lastname: Crinière
authors.affiliation: Service d'ophtalmologie, hôpital Bretonneau, centre hospitalier universitaire de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Faculté de médecine de Tours, 10, boulevard Tonnellé, BP 3223, 37032 Tours cedex 1, France.
authors.forename: Pierre-Jean
authors.initials: PJ
authors.lastname: Pisella
mesh_terms: D000328:Adult; D000368:Aged; D004351:Drug Resistance / Q000187:drug effects; D005260:Female; D005602:France; D005938:Glucocorticoids / Q000627:therapeutic use*; D049970:Graves Ophthalmopathy / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000069283:Rituximab / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D000069283:Rituximab
keywords: Anti-CD20; Graves ophthalmopathy; Neuropathie optique; Optic neuropathy; Orbitopathie basedowienne; Rituximab