Rapid response to and long-term effectiveness of anti-CD20 antibody in conventional therapy resistant Graves' orbitopathy: A five-year follow-up study

Annamaria Erdei, Gyorgy Paragh, Peter Kovacs, Zsolt Karanyi, Ervin Berenyi, Laszlo Galuska, Agota Lenkey, Lajos Szabados, Ferenc Gyory, Bernadett Ujhelyi, Andras Berta, Judit Boda, Eszter Berta, Miklos Bodor, Annamaria Gazdag, Endre V. Nagy

Research output: Contribution to journalArticle

11 Citations (Scopus)

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), 99mTc-labeled diethylene triamine pentaacetic acid (99mTc DTPA) single photon emission computed tomography and magnetic resonance imaging. Rituximab (RTX) was given as weekly infusions of 375mg/m2 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±4.51MBq/cm3 and decreased to 11.97±2.36MBq/cm3 at one year (p<0.002). The mean of T2 relaxation times before and one year after therapy were 96.91±17.61ms and 84.29±9.41ms, 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±3.4U/L, 5.6±4.5U/L and 1.7±1.5U/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.

Original languageEnglish
Pages (from-to)548-555
Number of pages8
JournalAutoimmunity
Volume47
Issue number8
DOIs
Publication statusPublished - Dec 1 2014

Keywords

  • Biological treatment
  • Endocrine orbitopathy
  • Graves'disease
  • Hyperthyroidism
  • Thyroid

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

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