Rituximab May Offer Hope To Severe Graves' Eye Disease Patients
There may be hope for patients with severe Graves’ eye disease in the form of treatment with the drug rituximab.
This news comes from U-M Kellogg Eye Center who’s oculoplastics specialist Raymond S. Douglas, M.D., Ph.D. reports on the potential of the drug in the online October issue of Ophthalmology.
Graves’ eye disease is an autoimmune disease that causes inflammation and fatty deposits in the eye muscles and connective tissue surrounding the eye.
Douglas reports on the progress of six patients (four women, two men) who had not responded to treatment using systemic corticosteroids. The patients were then treated with rituximab. All patients responded within 2 months with the clinical activity score (CAS) improving from5.5±0.8 to 1.3±0.5. The eye disease remained quiescent in all with the positive results being sustained at 4-6 months after treatment.
Vision improved bilaterally in all 4 patients with dysthyroid optic neuropathy (DON). Proptosis remained stable (Hertel measurement, 24±3.7 mm before therapy and 23.6±3.7 mm after therapy; P = 0.17).
"These patients had already received the maximum level of steroid treatment," says Douglas. "Treatment with rituximab calmed inflammation, stopped progression of the disease, and saved the patients from having to undergo surgery."
Graves' disease (also known as thyroid eye disease) is an autoimmune condition in which white blood cells attack the thyroid gland which responds by secreting an excess amount of thyroid hormone. The hypermetabolic state is characterized by fast pulse/heartbeat, palpitations, profuse sweating, high blood pressure, irritability, fatigue, weight loss, heat intolerance, and loss of hair and alterations in hair quality.
Rituximab has been used to treat patients with other autoimmune diseases, including rheumatoid arthritis and in non-Hodgkin's B-cell lymphoma. The drug works by depleting B cells -- the body's normal antibody-producing cells -- that appear to go awry in autoimmune diseases.
"Treatment of the inflammatory component of Graves' eye disease has not advanced appreciably over several decades," says Douglas. High-dose steroids, sometimes in combination with orbital radiation, are still the first line treatment. But, says Douglas, "These are imperfect options because inflammation often recurs when the treatment ends." He is hopeful that rituximab can offer sustained improvement. Douglas observes that the results from a small case series must be viewed with some caution. But given the substantial benefits for patients treated with rituximab, he sees good reason to proceed with a large-scale clinical trial to test this promising new drug.
Rituximab Treatment of Patients with Severe, Corticosteroid-Resistant Thyroid-Associated Ophthalmopathy; Ophthalmology, 2009; Chong et al.; DOI: 10.1016/j.ophtha.2009.05.029