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MabThera is effective in Graves' orbitopathy after steroids fail


A small group of patients with severe Graves' eye disease experienced rapid improvement of their symptoms — and improved vision — following treatment with the drug Rituximab MabThera, Rituxan ). Inflammation around their eyes and damage to the optic nerve were significantly reduced. The same patients had not previously responded to steroids.

Raymond S. Douglas reviewed the progress of six patients treated with Rituximab.

Graves' eye disease is an autoimmune disease that causes inflammation and fatty deposits in the eye muscles and connective tissue surrounding the eye. Among the symptoms are pronounced bulging eyes, retracted eyelids, dry eyes, and, in severe cases, loss of vision. Women are more likely than men to develop the disease.

The study suggests that Rituximab is a potentially effective new treatment for the most severe forms of Graves' eye disease.

Rituximab has been used to treat patients with other autoimmune diseases, including rheumatoid arthritis and in non-Hodgkin's B-cell lymphoma. The drug works by depleting B cells, the body's normal antibody-producing cells, that appear to go awry in autoimmune diseases.

Collaborating with Terry J. Smith, Douglas has helped to explain the process by which the immune system attacks the orbital tissue in Graves' eye disease. In an earlier study, the researchers reported that B cells play a pivotal role in the inflammatory process in Graves' eye disease.

In the current study, Douglas observed improvement among the patients, four of whom were women, as early as four weeks following the first infusion of Rituximab. Researchers also observed that the positive results were sustained 4 to 6 months after treatment.

Treatment of the inflammatory component of Graves' eye disease has not advanced appreciably over several decades. High-dose steroids, sometimes in combination with orbital radiation, are still the first line treatment. But these are imperfect options because inflammation often recurs when the treatment ends.

Source: University of Michigan Health System, 2009

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