Rituximab for the treatment of Graves' orbitopathy

Mario Salvi, Guia Vannucchi, Paolo Beck-Peccoz

Research output: Contribution to journalArticle

Abstract

The contribution of B-cells to human autoimmune disease has recently been underscored because of the therapeutic benefit of B-cell depleting therapies. B-cells are involved in the production of autoantibodies, and in CD4+ T-cell activation, control of T-cell function, and inflammation through cytokine production. B-cells are also important antigen-presenting cells. Rituximab (RTX) has been used off-label in various autoimmune disorders and has been shown to effectively deplete mature and memory CD20+ B-cells, but not long-lived plasma cells. The rationale behind the use of RTX in Graves' disease (GD) and Graves' orbitopathy (GO) relies on its putative effect on pathogenic autoantibodies causing hyperthyroidism. RTX in patients with active GO has been shown to have a significant effect on the inflammatory activity and severity of GO. However, caution is suggested before proposing RTX as a novel therapeutic tool in this disease until randomized controlled trials are available. Should preliminary observations be confirmed, an optimal strategy for controlling the progression of GO would be to pursue B-cell depletion shortly after diagnosis, rather than only as an alternative therapeutic option when standard immunosuppression has failed.

Original languageEnglish
Pages (from-to)130-136
Number of pages7
JournalUS Endocrinology
Volume7
Issue number2
Publication statusPublished - Dec 2011

Keywords

  • B lymphocytes
  • CD163
  • CD20
  • CD68
  • Graves disease (GD)
  • Graves orbitopathy (GO)
  • Rituximab
  • thyroglobulin antibodies (TGAb)
  • thyroid peroxidase antibodies (TPOAb)
  • Thyroid stimulating hormone receptor antibodies (TRAb)

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

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