Rituximab to Treat Thyroid-Associated Ophthalmopathy

January’s Ophthalmology

A retrospective, interventional case series by Chong et al. demonstrates a clinical benefit of anti-CD20 (rituximab) in the treatment of severe thyroid-associated ophthalmopathy that is refractory to corticosteroid therapy or orbital decompression.

Thyroid-associated ophthalmopathy affects 30 to 50 percent of patients with Graves’ disease. It is thought that B cells may produce autoantibodies against thyroid-stimulating hormone receptors and insulinlike growth factor-1 receptors. Rituximab depletes B cells by enhancing apoptosis and promoting antibody-dependent cellular toxicity and complement-dependent cellular toxicity. In the six patients studied, four developed dysthyroid optic neuropathy prior to the rituximab treatment. Orbital inflammation and dysthyroid optic neuropathy improved following rituximab treatment in all six patients. No one experienced disease relapse, and proptosis remained stable.

While the authors urge caution due to the uncontrolled nature of the study, they assert these data justify conducting prospective studies to determine whether rituximab is a viable alternative in patients with progressive, corticosteroid-resistant thyroid-associated ophthalmopathy.