Résumé

SY2-001

Role of the anti-CD20 antibody Rituximab in Graves' disease

M. Salvi*^a (Dr)

^a Graves’ Orbitopathy Center, Endocrinology, Fondazione Cà Granda, IRCCS and University of Milan, Milan, Italy, Milan, ITALIE

* mario@mariosalvinet.it

Since 2006, the effect of the anti-CD20 antibody rituximab (RTX) in patients with moderate-severe GO has been challenged in several non-controlled studies and, recently, in one randomized controlled trial vs placebo and in one vs steroids. We randomized 32 patients to RTX or ivMP and the CAS decreased at 24 weeks more significantly after RTX while 100% of patients improved compared to 69% after ivMP (P<0.001). 500 mg RTX was as effective as two doses of 1000 mg. Disease reactivation was never observed in patients after RTX, but in five (31%) after ivMP. There was no change of proptosis, but RTX was more effective on motility and quality of life. Stan and colleagues did not find RTX effective in treating active GO, when compared to placebo. The study was conducted on 21 patients, of whom two, after RTX, developed optic neuropathy. Major differences in this study are a much longer disease duration (11.2 vs 4.5 months), a greater number of patients previously treated with steroids (40 vs 19%) and less motility involvement (diplopia score 2 vs 3.5). Evidence is also emerging for therapeutic effectiveness even using much lower doses of RTX. We have also been using a single 100 mg dose of RTX in patients with moderate-severe GO and preliminary results show disease inactivation in more than 90% of patients. RTX may be a good alternative to steroids in non responders, as it has a disease modifying effect. RTX administration should be limited for now to experienced Centers.

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