B-Cell Targeted Therapy With Rituximab for Thyroid Eye Disease: Closer to the Clinic

• Published in: Survey of ophthalmology 2013-05, Vol.58 (3), p.252-265
• Main Authors: Shen, Sunny, MD, Chan, Anita, MD, Sfikakis, Petros P., MD, Hsiu Ling, Andrea Low, MD, Detorakis, Efstathios T., MD, Boboridis, Kostas G., MD, Mavrikakis, Ioannis, MD
• Format: Article
• Language: English
• Subjects: Adult; Antibodies, Monoclonal, Murine-Derived - therapeutic use; Antigens, CD20 - immunology; B-cells; B-Lymphocytes - drug effects; B-Lymphocytes - immunology; CD20; Female; Graves Ophthalmopathy - immunology; Graves Ophthalmopathy - therapy; Humans; Immunologic Factors - therapeutic use; immunopathogenesis; Molecular Targeted Therapy; Ophthalmology; Rituximab; thyroid eye disease; Treatment Outcome
• ISSN: 0039-6257; 1879-3304
• DOI: 10.1016/j.survophthal.2012.10.006

Abstract The management of thyroid eye disease (TED) remains a therapeutic challenge. The current established therapies are unsatisfactory in one-third of the patients and have many limitations. Rituximab (RTX) is a CD20+ B-cell–depleting monoclonal antibody approved for the treatment of non-Hodgkin lymphomas, chronic lymphocytic leukemia, and rheumatoid arthritis. The early experience with RTX suggests that it is a promising alternative therapy for TED. Rituximab may compare favorably to the conventional glucocorticoid therapy and causes less collateral damage than retrobulbar orbital radiation and decompression surgery. In addition, the preliminary studies on RTX’s proposed mechanism of action have revealed new insights into the pathogenic role of B-cells in TED. We summarize the current literature on the clinical application of RTX in TED and discuss its putative mechanisms of action.