Abumohssin Abdulelah G, Alshareef Rayan A, Aljohani Saja, Alqutub Abdulrahman, Alqutub Abdulsalam
Department of Ophthalmology, King Abdulaziz University, Jeddah, Saudi Arabia.
Department of Internal Medicine, Ministry of Health, Jeddah, Saudi Arabia.
Eye (Lond). 2025 May 22. doi: 10.1038/s41433-025-03845-8.
Graves' orbitopathy (GO) affects 25-50% of patients with Graves' disease. It progresses through phases, from active inflammation to fibrosis. Thyrotropin-related antibodies (TRAb) and Insulin-like growth factor (IGF-1) contribute to GO's pathogenesis. Conventional treatments like glucocorticoids are often effective, but refractory cases require alternatives like rituximab (RTX), tocilizumab (TCZ), and teprotumumab (TPM). These monoclonal antibodies show promise but carry significant risks. This review aims to assess their efficacy and safety. We retrieved relevant articles up to July 2024 from five databases. Data were extracted from eligible studies by two independent reviewers, including clinical activity scores 7 and 10 (CAS), proptosis, antibody levels, and diplopia. All analyses were conducted using RevMan v5.4. In this review, we included 77 articles. Of these, 58 provided enough data for analysis. TPM, RTX, and TCZ all significantly reduced CAS-7 scores, with TCZ showing the most significant reduction (3.51 points, 95%CI: -4.25, -2.78), followed by TPM (3.1 points, 95%CI: -3.71, -2.49) and RTX. Similarly, for CAS-10, TCZ led with a 5.12-point reduction, significantly outperforming RTX (P = 0.0006). Proptosis decreased significantly with each drug, with TPM leading (2.95 mm), followed by TCZ (1.99 mm) and RTX (0.79 mm). TRAb Levels: TCZ reduced TRAb levels by 8.29 U/L (95%CI: -10.48, -6.09), significantly more than RTX (P = 0.03). Complications varied, with TPM linked to hyperglycemia and ototoxicity, TCZ to hematologic and metabolic issues, and RTX to infusion-related reactions. In conclusion, TCZ and TPM outperform RTX in treating GO, but TPM has higher complications, and RTX, though safer, shows more treatment failures.
格雷夫斯眼眶病（GO）影响25%至50%的格雷夫斯病患者。它会经历从活动性炎症到纤维化的各个阶段。促甲状腺素相关抗体（TRAb）和胰岛素样生长因子（IGF-1）参与GO的发病机制。糖皮质激素等传统治疗方法通常有效，但难治性病例需要诸如利妥昔单抗（RTX）、托珠单抗（TCZ）和替普罗珠单抗（TPM）等替代方案。这些单克隆抗体显示出前景，但也有重大风险。本综述旨在评估它们的疗效和安全性。我们从五个数据库中检索了截至2024年7月的相关文章。由两名独立审阅者从符合条件的研究中提取数据，包括临床活动评分7和10（CAS）、眼球突出度、抗体水平和复视。所有分析均使用RevMan v5.4进行。在本综述中，我们纳入了77篇文章。其中，58篇提供了足够的数据用于分析。TPM、RTX和TCZ均显著降低了CAS-7评分，其中TCZ降低最为显著（3.51分，95%置信区间：-4.25，-2.78），其次是TPM（3.1分，95%置信区间：-3.71，-2.49）和RTX。同样，对于CAS-10，TCZ降低了5.12分，显著优于RTX（P = 0.0006）。每种药物治疗后眼球突出度均显著降低，TPM降低幅度最大（2.95毫米），其次是TCZ（1.99毫米）和RTX（0.79毫米）。TRAb水平：TCZ使TRAb水平降低了8.29 U/L（95%置信区间：-10.4 S 8，-6.09），显著多于RTX（P = 0.03）。并发症各不相同，TPM与高血糖和耳毒性有关，TCZ与血液学和代谢问题有关，RTX与输液相关反应有关。总之，在治疗GO方面，TCZ和TPM优于RTX，但TPM的并发症更多，RTX虽然更安全，但治疗失败率更高。
