Advances in treatment of active, moderate-to-severe Graves' ophthalmopathy.
Identifieur interne : 001915 ( Main/Exploration ); précédent : 001914; suivant : 001916Advances in treatment of active, moderate-to-severe Graves' ophthalmopathy.
Auteurs : Wilmar M. Wiersinga [Pays-Bas]Source :
- The lancet. Diabetes & endocrinology [ 2213-8595 ] ; 2017.
Descripteurs français
- KwdFr :
- Animaux, Anticorps monoclonaux (administration et posologie), Essais contrôlés randomisés comme sujet (), Facteurs immunologiques (administration et posologie), Glucocorticoïdes (administration et posologie), Humains, Indice de gravité médicale, Maladie de Basedow (diagnostic), Maladie de Basedow (immunologie), Maladie de Basedow (traitement médicamenteux), Méthylprednisolone (administration et posologie), Ophtalmopathie basedowienne (diagnostic), Ophtalmopathie basedowienne (immunologie), Ophtalmopathie basedowienne (traitement médicamenteux), Rituximab (administration et posologie), Résultat thérapeutique.
- MESH :
- administration et posologie : Anticorps monoclonaux, Facteurs immunologiques, Glucocorticoïdes, Méthylprednisolone, Rituximab.
- diagnostic : Maladie de Basedow, Ophtalmopathie basedowienne.
- immunologie : Maladie de Basedow, Ophtalmopathie basedowienne.
- traitement médicamenteux : Maladie de Basedow, Ophtalmopathie basedowienne.
- Animaux, Essais contrôlés randomisés comme sujet, Humains, Indice de gravité médicale, Résultat thérapeutique.
English descriptors
- KwdEn :
- Animals, Antibodies, Monoclonal (administration & dosage), Glucocorticoids (administration & dosage), Graves Disease (diagnosis), Graves Disease (drug therapy), Graves Disease (immunology), Graves Ophthalmopathy (diagnosis), Graves Ophthalmopathy (drug therapy), Graves Ophthalmopathy (immunology), Humans, Immunologic Factors (administration & dosage), Methylprednisolone (administration & dosage), Randomized Controlled Trials as Topic (methods), Rituximab (administration & dosage), Severity of Illness Index, Treatment Outcome.
- MESH :
- chemical , administration & dosage : Antibodies, Monoclonal, Glucocorticoids, Immunologic Factors, Methylprednisolone, Rituximab.
- diagnosis : Graves Disease, Graves Ophthalmopathy.
- drug therapy : Graves Disease, Graves Ophthalmopathy.
- immunology : Graves Disease, Graves Ophthalmopathy.
- methods : Randomized Controlled Trials as Topic.
- Animals, Humans, Severity of Illness Index, Treatment Outcome.
Abstract
Graves' ophthalmopathy is defined as autoimmune inflammation of extraocular muscles and orbital fat or connective tissue, usually in patients with Graves' disease. About one in 20 patients with Graves' hyperthyroidism has moderate-to-severe Graves' ophthalmopathy. Corticosteroids have been the mainstay of treatment, but new evidence about immune mechanisms has provided a basis to explore other drug classes. Intravenous methylprednisolone pulses are more effective and better tolerated than oral prednisone in the treatment of active, moderate-to-severe Graves' ophthalmopathy. Rituximab has also been suggested as a possible replacement for intravenous corticosteroids. Two randomised controlled trials of rituximab reached seemingly contradictory conclusions-rituximab was not better with respect to the primary outcome (clinical activity score) than placebo in one trial (which, however, was confounded by rather long Graves' ophthalmopathy duration), but was slightly better than intravenous methylprednisolone pulses in the other (disease flare-ups occurred only in the latter group). On the basis of evidence published so far, rituximab cannot replace intravenous methylprednisolone pulses, but could have a role in corticosteroid-resistant cases. Open-label studies of tumour-necrosis-factor-α blockade had limited efficacy, but other studies showed that interleukin-6 receptor antibodies were effective. Results of randomised controlled trials investigating the efficacy of the IGF-1 receptor antibody teprotumumab and the interleukin-6 receptor antibody tocilizumab are expected shortly. Approaches that target the causal mechanism of Graves' ophthalmopathy (antibodies or antagonists that block thyroid-stimulating-hormone receptors) also look promising.
DOI: 10.1016/S2213-8587(16)30046-8
PubMed: 27346786
Affiliations:
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Le document en format XML
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Wiersinga</name><affiliation wicri:level="4"><nlm:affiliation>Department of Endocrinology and Metabolism, Academic Medical Centre, University of Amsterdam, Netherlands. Electronic address: w.m.wiersinga@amc.uva.nl.</nlm:affiliation><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Endocrinology and Metabolism, Academic Medical Centre, University of Amsterdam</wicri:regionArea><placeName><settlement type="city">Amsterdam</settlement><region>Hollande-Septentrionale</region></placeName><orgName type="university">Université d'Amsterdam</orgName></affiliation></author></analytic><series><title level="j">The lancet. 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About one in 20 patients with Graves' hyperthyroidism has moderate-to-severe Graves' ophthalmopathy. Corticosteroids have been the mainstay of treatment, but new evidence about immune mechanisms has provided a basis to explore other drug classes. Intravenous methylprednisolone pulses are more effective and better tolerated than oral prednisone in the treatment of active, moderate-to-severe Graves' ophthalmopathy. Rituximab has also been suggested as a possible replacement for intravenous corticosteroids. Two randomised controlled trials of rituximab reached seemingly contradictory conclusions-rituximab was not better with respect to the primary outcome (clinical activity score) than placebo in one trial (which, however, was confounded by rather long Graves' ophthalmopathy duration), but was slightly better than intravenous methylprednisolone pulses in the other (disease flare-ups occurred only in the latter group). On the basis of evidence published so far, rituximab cannot replace intravenous methylprednisolone pulses, but could have a role in corticosteroid-resistant cases. Open-label studies of tumour-necrosis-factor-α blockade had limited efficacy, but other studies showed that interleukin-6 receptor antibodies were effective. Results of randomised controlled trials investigating the efficacy of the IGF-1 receptor antibody teprotumumab and the interleukin-6 receptor antibody tocilizumab are expected shortly. Approaches that target the causal mechanism of Graves' ophthalmopathy (antibodies or antagonists that block thyroid-stimulating-hormone receptors) also look promising.</div></front></TEI><affiliations><list><country><li>Pays-Bas</li></country><region><li>Hollande-Septentrionale</li></region><settlement><li>Amsterdam</li></settlement><orgName><li>Université d'Amsterdam</li></orgName></list><tree><country name="Pays-Bas"><region name="Hollande-Septentrionale"><name sortKey="Wiersinga, Wilmar M" sort="Wiersinga, Wilmar M" uniqKey="Wiersinga W" first="Wilmar M" last="Wiersinga">Wilmar M. Wiersinga</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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