Systemic adverse events following rituximab therapy in patients with Graves' disease
Systemic adverse events following rituximab therapy in patients with Graves' disease
复制标题
DOI：
10.3275/7411
复制
发表时间：
2011-07-01
影响因子：
5.4
通讯作者：
Hegedus, L.
中科院分区：
文献类型：
--
作者：
El Fassi, D.;Nielsen, C. H.;Hegedus, L.
背景和目的：利妥昔单抗（RTX）治疗Graves病（GD），无论有无眼病，均显示出良好的疗效。我们研究了接受RTX治疗的GD患者不良事件的发生率。对象和方法：10例患者接受RTX和他巴唑，而10例患者仅接受他巴唑。记录不良事件，并将循环免疫复合物（CIC）的存在测量为与患者血浆孵育后沉积在正常单核细胞上的IgG、IgM和补体成分3（C3）。结果：5例患者在首次输注时发生了良性输注相关不良事件。两名患者在第一次RTX输注后11天出现血清病样反应。其中1例患者在1年后出现腹泻、类粘蛋白水平升高、结肠镜活检轻度炎症和虹膜睫状体炎。在第14天，在存在来自这2名患者的血浆的情况下观察到最明显的免疫球蛋白/C3-粘附至测试单核细胞，指示CIC（p=0.003至p=0.01 vs无症状患者）。第3例患者从第38天开始出现反复发热和对称性多关节炎，第68天结肠镜检查证实为溃疡性结肠炎。到第14天，该患者单核细胞上IG沉积增加第3高。2例患者尽管接受糖皮质激素抢救治疗，关节痛仍持续存在。结论：我们报告了10例接受RTX治疗但未同时使用免疫抑制剂的GD患者中3例出现关节不良事件，2例出现胃肠道症状。关节症状与CIC形成有关。(J.年. Invest. 34：e163-e167，2011）（C）2011，Editrice Kurt's
Background and aim: Rituximab (RTX) therapy has shown promising results in Graves' disease (GD), with or without ophthalmopathy. We examined the occurrence of adverse events in GD patients treated with RTX. Subjects and methods: Ten patients received RTX and methimazole, while 10 patients received methimazole only. Adverse events were recorded, and the presence of circulating immune complexes (CIC) was measured as IgG, IgM and complement component 3 (C3) depositing on normal monocytes following incubation with patient plasma. Results: Five patients had benign infusion-related adverse events at first infusion. Two patients developed a serum sickness-like reaction 11 days after the first RTX-infusion. One of these patients developed diarrhea, raised orosomucoid levels, low-grade inflammation in colonoscopic biopsies, and iridocyclitis 1 yr later. At day 14, the most pronounced immunoglobulin/C3-adherent to the test monocytes, indicative of CIC, was observed in the presence of plasma from these 2 patients (p=0.003 to p=0.01 vs asymptomatic patients). A 3(rd) patient had recurrent fever and symmetric polyarthritis from day 38, and colonoscopy-verified ulcerative colitis at day 68. This patient had the 3rd highest increase in Ig deposition on monocytes by day 14. The arthralgias persisted in 2 of the patients, despite glucocorticoid rescue therapy. Conclusions: We report articular adverse events in 3 and gastrointestinal symptoms in 2 out of 10 GD patients who received RTX without concurrent immunosupression. The joint symptoms were related to CIC formation. (J. Endocrinol. Invest. 34: e163-e167, 2011) (C) 2011, Editrice Kurt's