Targeted biological therapies for Graves' disease and thyroid-associated ophthalmopathy. Focus on B-cell depletion with Rituximab.
Targeted biological therapies for Graves' disease and thyroid-associated ophthalmopathy. Focus on B-cell depletion with Rituximab.
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DOI：
10.1111/j.1365-2265.2010.03806.x
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发表时间：
2011-01
影响因子：
3.2
通讯作者：
Nielsen CH
中科院分区：
文献类型：
--
作者：
Hegedüs L;Smith TJ;Douglas RS;Nielsen CH
基于其他自身免疫性疾病的治疗经验，由于Graves病（GD）和甲状腺相关眼病（TAO）的现有治疗方案存在固有缺陷，最近引入了利妥昔单抗作为一种新的治疗方案。在这里，我们总结了使用利妥昔单抗的基本原理;概述了可能的作用机制;并说明了其在GD和TAO中使用时的作用和副作用。低质量的证据，来自少数和方法学上不均匀的研究，表明利妥昔单抗可能延长缓解甲状腺功能亢进症的抗甲状腺药物，至少在轻度GD。此外，在对常规免疫抑制治疗无反应的TAO患者中，利妥昔单抗似乎有效。在等待大规模的随机研究，利妥昔单抗，由于有限的经验和高成本，应被视为实验性的，并保留给病人谁不响应良好的常规治疗。利妥昔单抗是一系列新的和新兴的治疗方法中的第一个，这些治疗方法针对特定的治疗靶点，例如，这将有望改善和更好地定制GD，特别是TAO的个体化治疗。
Based on experience from the treatment of other autoimmune diseases and due to inherent shortcomings of the existing therapy options for Graves’ disease (GD) and thyroid associated ophthalmopathy (TAO), rituximab was recently introduced as a novel therapy option. Here we summarize the rationale for using rituximab; give an overview of the possible mechanisms of action; and give an account of its effects and side effects when used in GD and TAO. Low quality evidence, originating from few and methodologically inhomogeneous studies, suggests that rituximab may prolong remission for hyperthyroidism over that seen with antithyroid drugs, at least in mild GD. Furthermore, in TAO patients, unresponsive to conventional immunosuppressive therapy, rituximab seems efficacious. Awaiting large-scale randomized studies, rituximab, due to limited experience and high cost, should be considered experimental and reserved for patients who do not respond favourably to conventional therapy. Rituximab is the first in a series of new and emerging treatments addressing specific therapeutic targets, such as, which will hopefully lead to improved and better tailored individualized therapy for GD and especially TAO.
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