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Edited by Yimaitong, please do not reprint without authorization
.
Active thyroid eye disease (TED) has always been a difficult clinical diagnosis and treatment.
With the progress of research, it has been found that rituximab may be helpful for the treatment of the disease, but different drug doses seem to bring about the efficacy and safety.
significant differences in gender
.
Recently, an article published in the journal Clinical & experimental ophthalmology (IF: 3.
411) pointed out that low-dose rituximab (100mg) for the treatment of active TED may have better therapeutic prospects
.
The corresponding author is Sugapriyan Ravichandran from Hawke's Bay Memorial Hospital, New Zealand
.
We read with interest a review article entitled Thyroid eye disease: redefining its management, which provides a comprehensive overview of TED and its current management strategies
.
We would like to share insights from a single low-dose injection of rituximab (100 mg) for the treatment of active TED
.
Controversy on the efficacy of high-dose rituximab Rituximab suppresses the immune system by depleting CD19+ and CD20+ B lymphocytes, and was first used to treat active TED in 2006
.
Several studies have investigated the role of rituximab as corticosteroid-sparing in active TED
.
Due to the lack of high-level documentation, the appropriate dose of rituximab in this setting is unclear
.
The papers cited in the review reported standard rheumatic doses; two 1000 mg intravenous injections, two weeks apart
.
These studies have shown "mixed results" with rituximab, while reporting significant side effects such as allergic reactions and infections
.
Low-dose rituximab shows promising therapeutic prospects We would like to draw attention to a study published by a team at the Oxford Joint Thyroid Eye Clinic (Ox TED) demonstrating that a single low-dose rituximab Monoclonal antibody therapy can effectively reduce B lymphocytes and inflammation
.
In this report (titled: Early low-dose rituximab in active thyroid eye disease: an effective and well-tolerated treatment option), 12 patients with active TED (7-point scale, CAS ≥ 3 points) ), given 100 mg rituximab infusion and 500 mg intravenous methylprednisolone
.
The regimen proved to be highly effective, resulting in a statistically significant reduction in Clinical Activity Score (CAS) and reduction in B lymphocytes
.
It was also a safe regimen with no significant adverse events
.
The only side effect was an infusion-related rash in one-third of patients
.
In this cohort, the mean cumulative dose of intravenous methylprednisolone was nearly half of the EUGOGO recommended dose
.
Although some patients received more than 500 ng of methylprednisolone intravenously, the average total dose was 2.
3 grams
.
For patients referred directly to Ox TED, corticosteroid dosage was reduced to an average of 1.
5 grams and received their first treatment within 10 days
.
In addition to reducing morbidity and mortality associated with the cumulative effect of corticosteroids, the low-dose rituximab infusion regimen also reduced the burden of patient visits and associated costs, with an average of 4 treatments compared to the EUGOGO recommendation within 3 months 12 treatments were performed
.
Considering this is a small, non-randomized study, a large multicenter randomized controlled clinical trial is expected to evaluate the efficacy and safety of "low-dose rituximab in active TED" in the future
.
Yimaitong compiled and compiled from: [1]Ravichandran S, Insull E, Norris J.
Low-dose rituximab: Useful in the armamentarium for treatment of active thyroid eye disease[J].
Clin Exp Ophthalmol.
2022.
DOI: 10.
1111/ceo .
14030, PMID:35037368.
[2]Insull EA, Sipkova Z, David J, Turner HE, Norris JH.
Early low-dose rituximab for active thyroid eye disease: an effective and well-tolerated treatment.
Clin Endocrinol(Oxf).
2019;91:179-186.
.
Active thyroid eye disease (TED) has always been a difficult clinical diagnosis and treatment.
With the progress of research, it has been found that rituximab may be helpful for the treatment of the disease, but different drug doses seem to bring about the efficacy and safety.
significant differences in gender
.
Recently, an article published in the journal Clinical & experimental ophthalmology (IF: 3.
411) pointed out that low-dose rituximab (100mg) for the treatment of active TED may have better therapeutic prospects
.
The corresponding author is Sugapriyan Ravichandran from Hawke's Bay Memorial Hospital, New Zealand
.
We read with interest a review article entitled Thyroid eye disease: redefining its management, which provides a comprehensive overview of TED and its current management strategies
.
We would like to share insights from a single low-dose injection of rituximab (100 mg) for the treatment of active TED
.
Controversy on the efficacy of high-dose rituximab Rituximab suppresses the immune system by depleting CD19+ and CD20+ B lymphocytes, and was first used to treat active TED in 2006
.
Several studies have investigated the role of rituximab as corticosteroid-sparing in active TED
.
Due to the lack of high-level documentation, the appropriate dose of rituximab in this setting is unclear
.
The papers cited in the review reported standard rheumatic doses; two 1000 mg intravenous injections, two weeks apart
.
These studies have shown "mixed results" with rituximab, while reporting significant side effects such as allergic reactions and infections
.
Low-dose rituximab shows promising therapeutic prospects We would like to draw attention to a study published by a team at the Oxford Joint Thyroid Eye Clinic (Ox TED) demonstrating that a single low-dose rituximab Monoclonal antibody therapy can effectively reduce B lymphocytes and inflammation
.
In this report (titled: Early low-dose rituximab in active thyroid eye disease: an effective and well-tolerated treatment option), 12 patients with active TED (7-point scale, CAS ≥ 3 points) ), given 100 mg rituximab infusion and 500 mg intravenous methylprednisolone
.
The regimen proved to be highly effective, resulting in a statistically significant reduction in Clinical Activity Score (CAS) and reduction in B lymphocytes
.
It was also a safe regimen with no significant adverse events
.
The only side effect was an infusion-related rash in one-third of patients
.
In this cohort, the mean cumulative dose of intravenous methylprednisolone was nearly half of the EUGOGO recommended dose
.
Although some patients received more than 500 ng of methylprednisolone intravenously, the average total dose was 2.
3 grams
.
For patients referred directly to Ox TED, corticosteroid dosage was reduced to an average of 1.
5 grams and received their first treatment within 10 days
.
In addition to reducing morbidity and mortality associated with the cumulative effect of corticosteroids, the low-dose rituximab infusion regimen also reduced the burden of patient visits and associated costs, with an average of 4 treatments compared to the EUGOGO recommendation within 3 months 12 treatments were performed
.
Considering this is a small, non-randomized study, a large multicenter randomized controlled clinical trial is expected to evaluate the efficacy and safety of "low-dose rituximab in active TED" in the future
.
Yimaitong compiled and compiled from: [1]Ravichandran S, Insull E, Norris J.
Low-dose rituximab: Useful in the armamentarium for treatment of active thyroid eye disease[J].
Clin Exp Ophthalmol.
2022.
DOI: 10.
1111/ceo .
14030, PMID:35037368.
[2]Insull EA, Sipkova Z, David J, Turner HE, Norris JH.
Early low-dose rituximab for active thyroid eye disease: an effective and well-tolerated treatment.
Clin Endocrinol(Oxf).
2019;91:179-186.