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Immunotherapy for Graves’ ophthalmopathy

Salvi, Mario

Current Opinion in Endocrinology & Diabetes and Obesity: October 2014 - Volume 21 - Issue 5 - p 409–414
doi: 10.1097/MED.0000000000000097
THYROID: Edited by Lewis E. Braverman and Angela M. Leung
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Purpose of review In recent years, immunosuppressive therapy, as an alternative to corticosteroids, has been proposed as novel agents which target the various antigens involved in the pathogenesis of Graves’ ophthalmopathy. Although the lack of randomized and controlled studies suggests caution in generalizing results, some data show interesting results.

Recent findings Potential targets for immune therapy in Graves’ ophthalmopathy are the antigens expressed on the target organ of inflammation, namely the receptor and the insulin growth factor -1 receptor on fibroblasts, inflammatory cytokines, and B and T cells. The most promising results are observed with small thyroid stimulating hormone receptor molecules interacting with the receptor on thyrocytes and fibroblasts and with the anti-IGF-1 receptor antibody teprotumumab. A recent open study with tocilizumab, an anti-soluble interleukin-6 receptor, has shown inactivation of Graves’ ophthalmopathy. Consistent reports on the efficacy of rituximab will have to be confirmed by randomized controlled trials, which are now in progress.

Summary Current clinical practice for Graves’ ophthalmopathy will greatly benefit from the availability of immunosuppressors that act as disease-modifying drugs, as compared to steroids, the current standard treatment for Graves’ ophthalmopathy. Rituximab seems to be a good candidate, as preliminary results from ongoing randomized trials suggest good efficacy with a relative well tolerated profile.

Graves’ Orbitopathy Unit, Fondazione Cà Granda, IRCCS, Department of Clinical and Community Sciences, University of Milan, Milan, Italy

Correspondence to Mario Salvi, MD, Graves’ Orbitopathy Unit, Fondazione Cà Granda, IRCCS, Department of Clinical and Community Sciences, University of Milan, Via Sforza, 35, 20122 Milan, Italy. Tel: +39 0250320609; e-mail: mario@mariosalvinet.it

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins