PMID- 29601105
OWN - NLM
STAT- MEDLINE
DCOM- 20190307
LR  - 20190307
IS  - 1875-9114 (Electronic)
IS  - 0277-0008 (Linking)
VI  - 38
IP  - 5
DP  - 2018 May
TI  - Efficacy and Safety of Rituximab for the Treatment of Graves' Orbitopathy: A 
      Meta-analysis of Randomized Controlled Trials.
PG  - 503-510
LID - 10.1002/phar.2111 [doi]
AB  - STUDY OBJECTIVE: To investigate the efficacy and safety of rituximab in patients 
      with Graves' orbitopathy (GO). DESIGN: Systematic review and meta-analysis of 
      four randomized controlled trials. PATIENTS: A total of 293 patients with GO who 
      received rituximab or control (either glucocorticoids, the established first-line 
      therapy [three trials], or saline [one trial]). MEASUREMENTS AND RESULTS: 
      Relevant studies published before February 2018 were identified from the PubMed, 
      EMBASE, Cochrane Library, and Scopus databases and the ClinicalTrials.gov 
      registry. Individual effect sizes were standardized, and a meta-analysis was 
      conducted to calculate the pooled effect size by using a random-effects model. 
      Treatment efficacy was assessed by measuring the following outcomes: clinical 
      activity score (CAS), sight visual acuity reduction (NOSPECS) score, proptosis, 
      diplopia, changes in eye volume, quality of life, and adverse events. In the four 
      included trials, 113 patients in the rituximab group and 108 patients in the 
      control group were evaluated. Compared with the control group, CAS (weighted mean 
      difference 0.57, 95% confidence interval 0.25-0.89) was significantly reduced at 
      24 weeks in the rituximab group. Compared with the control group, considerable 
      proptosis reduction was also observed in the rituximab group; however, the 
      difference was not significant. The proportion of adverse events in the rituximab 
      group was not significantly higher than that in the glucocorticoid control group, 
      but one of the included trials indicated that the rituximab group had more 
      serious adverse events than the saline control group. CONCLUSION: Rituximab is a 
      relatively safe and viable treatment that is superior to glucocorticoids or 
      saline for patients with moderate to severe GO. However, the incidence of serious 
      adverse events was disparate among the included trials. Additional studies 
      involving a larger sample size and investigating the optimal rituximab dosage, 
      frequency, and method of administration are warranted.
CI  - (c) 2018 Pharmacotherapy Publications, Inc.
FAU - Shen, Wan-Chen
AU  - Shen WC
AD  - Department of Pharmacy, Taipei Medical University-Shuang Ho Hospital, New Taipei 
      City, Taiwan.
AD  - College of Pharmacy, Taipei Medical University, Taipei, Taiwan.
FAU - Lee, Chia-Hwa
AU  - Lee CH
AD  - School of Medical Laboratory Science and Biotechnology, College of Medical 
      Science and Technology, Taipei Medical University, Taipei, Taiwan.
AD  - Comprehensive Cancer Center of Taipei Medical University, Taipei, Taiwan.
AD  - Department of Laboratory Medicine, Taipei Medical University-Shuang Ho Hospital, 
      Taipei, Taiwan.
FAU - Loh, El-Wui
AU  - Loh EW
AD  - Center for Evidence-Based Health Care, Department of Medical Research, Taipei 
      Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.
FAU - Hsieh, An-Tsz
AU  - Hsieh AT
AD  - Division of Endocrinology & Metabolism, Department of Internal Medicine, Taipei 
      Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.
AD  - Department of Internal Medicine, School of Medicine, College of Medicine, Taipei 
      Medical University, Taipei, Taiwan.
FAU - Chen, Lawrence
AU  - Chen L
AD  - Lake Erie College of Osteopathic Medicine, Bradenton, Florida.
FAU - Tam, Ka-Wai
AU  - Tam KW
AD  - Center for Evidence-Based Health Care, Department of Medical Research, Taipei 
      Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.
AD  - Division of General Surgery, Department of Surgery, Taipei Medical 
      University-Shuang Ho Hospital, New Taipei City, Taiwan.
AD  - Department of Surgery, School of Medicine, College of Medicine, Taipei Medical 
      University, Taipei, Taiwan.
AD  - Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Systematic Review
PL  - United States
TA  - Pharmacotherapy
JT  - Pharmacotherapy
JID - 8111305
RN  - 0 (Glucocorticoids)
RN  - 0 (Immunologic Factors)
RN  - 4F4X42SYQ6 (Rituximab)
SB  - IM
MH  - Glucocorticoids/adverse effects/therapeutic use
MH  - Graves Ophthalmopathy/*drug therapy/physiopathology
MH  - Humans
MH  - Immunologic Factors/adverse effects/*therapeutic use
MH  - Quality of Life
MH  - Randomized Controlled Trials as Topic
MH  - Rituximab/adverse effects/*therapeutic use
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Graves' ophthalmopathy
OT  - Graves' orbitopathy
OT  - glucocorticoids
OT  - rituximab
OT  - thyroid eye disease
EDAT- 2018/03/31 06:00
MHDA- 2019/03/08 06:00
CRDT- 2018/03/31 06:00
PHST- 2018/03/31 06:00 [pubmed]
PHST- 2019/03/08 06:00 [medline]
PHST- 2018/03/31 06:00 [entrez]
AID - 10.1002/phar.2111 [doi]
PST - ppublish
SO  - Pharmacotherapy. 2018 May;38(5):503-510. doi: 10.1002/phar.2111.