Department of Neuroscience, University of Naples -Federico II, Naples, Italy and, - Orbital Unit-King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy.
Eye (Lond). 2019 Feb;33(2):191-199. doi: 10.1038/s41433-018-0315-9. Epub 2019 Jan 4.
Recent new insights into the molecular basis of thyroid eye disease have led to the use of more specific therapies such as monoclonal antibodies This review explores the traditional immunosuppressant therapy for TED, highlighting the basis for emergent recent medications, possible treatment options and, eventually possible new general recommendation for management of TED. Data has been retrieved from the literature searching on Pubmed. Steroid therapy remains the first line therapy for moderate/severe and severe vision threatening TED The use of some traditional nonspecific immunosuppressant such as mycophenolate, cyclosporine and azathioprine seems useful in combination with steroid therapy to achieve stable results in the long term; methotrexate is useful as steroid-sparing medications and in steroid resistant or intolerant patients. In recent years, many scientific reports have showed the effectiveness of biological immunosuppressive agents in the management of TED. Etanercept, adalimumab, and tocilizumab have shown to be effective in reduction of the inflammatory signs with the possible advantage to prevent relapse of the disease. Particularly Tociliuzumab seems very effective as second line therapy, after steroid failure. Teprotumumab may control the disease activity and it seems to be very effective in preventing severity disease progression. Infliximab might be useful in severe TED with optic nerve compression resistant to steroid and decompression. Indeed, the actual incidence of adverse effects is not well assessed yet, therefore the use should be limited at those cases that really need an alternative therapy to steroid, handled by an expert multidisciplinary team.
最近，对甲状腺眼病分子基础的新认识导致了更具特异性的治疗方法的应用，如单克隆抗体。这篇综述探讨了 TED 的传统免疫抑制治疗，强调了新兴药物的基础、可能的治疗选择，最终可能对 TED 管理的新一般建议。数据是通过在 Pubmed 上搜索文献检索到的。类固醇治疗仍然是中重度和重度威胁视力的 TED 的一线治疗方法。一些传统的非特异性免疫抑制剂的使用，如霉酚酸酯、环孢素和硫唑嘌呤，似乎与类固醇联合治疗在长期内可获得稳定的效果；甲氨蝶呤可作为类固醇保留药物，在类固醇耐药或不耐受的患者中使用。近年来，许多科学报告表明生物免疫抑制剂在 TED 管理中的有效性。依那西普、阿达木单抗和托珠单抗已被证明可有效减轻炎症迹象，并可能具有预防疾病复发的优势。特别是托珠单抗作为二线治疗药物，在类固醇治疗失败后，似乎非常有效。特普鲁单抗可控制疾病活动，似乎在预防严重疾病进展方面非常有效。英夫利昔单抗可能对类固醇耐药和减压后视神经受压的严重 TED 有效。事实上，不良事件的实际发生率尚未得到很好的评估，因此，应将其限制在那些真正需要替代类固醇治疗的病例中，由专家多学科团队处理。
