B-cell depletion with rituximab in the treatment of autoimmune diseases: Graves' ophthalmopathy the latest addition to an expanding family

In this review, the authors summarise the clinical results obtained after therapy with rituximab in autoimmune dieases, including Graves' disease and Graves' ophthalmopathy. On the basis of qualitative and quantitative analyses of B- and T-cell subsets, and autoantibody levels obtained in other diseases before and after rituximab therapy, the authors interpret the results of the only two clinical investigtions of the efficacy of rituximab in the treatment of Graves' disease and Graves' opthalmopathy reported so far. No significant effect on autoantibody levels was observed. Nonetheless, 4 out of 10 Graves' disease patients remained in remission 400 days after rituximab treatment versus none in the control group, and remarkable improvements in the eye symptoms of patients with Graves' ophthalmopathy were observed. This supports a role for B cells in the pathogenesis of Graves' ophthalmopathy, and the authors suggest that abrogation of antigen presentation by B cells accounts for the effect of rituximab. In the authors' opinion, the use of rituximab in severe Graves' ophthalmopathy could be contemplated.