Rituximab May be Helpful in Graves` Orbitopathy

By David Douglas

NEW YORK (Reuters Health) - Compared to IV methylprednisolone for Graves' orbitopathy, rituximab offers a number of advantages, Italian researchers say.

Dr. Mario Salvi told Reuters Health by email, "In this study the unexpected findings were that Graves' orbitopathy after rituximab therapy does not relapse, when compared to a relapse rate of about 20-25% after standard treatment with steroids, observed after discontinuation of intravenous methylprednisolone."

In a December 15th online paper in the Journal of Clinical Endocrinology & Metabolism, Dr. Salvi of the University of Milan and colleagues report on 31 patients randomized to IV methylprednisolone 7.5 mg or rituximab 500 g or 2000 g (i.e., 1000 g twice).

The clinical activity score fell with both treatments, but results with rituximab were significantly better at 16, 20 and 24 weeks. This was the case with both 2000 g and 500 g, with no significant difference between them.

In addition, at 24 weeks all rituximab patients had improved, compared to 69% of those in the methylprednisolone group. Motility scores in both left and right eyes were also better at 52 weeks. No disease reactivation was seen in the rituximab group, but five patients in the methylprednisolone group relapsed.

At 76 weeks, 12 of the 16 methylprednisolone patients had undergone rehabilitative surgical procedures, significantly more than 5 of the 15 patients given rituximab.

The results of this trial, say the investigators, confirm preliminary reports of a better therapeutic outcome with rituximab.

Dr. Salvi observed, "One single 500 mg dose of rituximab is as effective as 1000 mg twice in active Graves' orbitopathy, suggesting that lower doses of this drug might be employed in this disease with the advantage of a lower risk for potential side effects and a lower therapeutic cost."

"We, at the moment, recommend rituximab to be used in specialized centers for the care of Graves' orbitopathy," he concluded.

SOURCE: https://bit.ly/1Bl6Cdc

J Clin Endocrinol Metab 2014.

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