Antithymocyte Globulin as Second-Line Therapy in Graves Orbitopathy-Preliminary Results From a Prospective Single-Center Study

Monika Sarnat-Kucharczyk, Maria Świerkot, Gabriela Handzlik, Grażyna Kulawik, Krystyna Jagoda, Iga Grochoła-Małecka, Joanna Fryżewska, Ewa Mrukwa-Kominek, Jerzy Chudek, Monika Sarnat-Kucharczyk, Maria Świerkot, Gabriela Handzlik, Grażyna Kulawik, Krystyna Jagoda, Iga Grochoła-Małecka, Joanna Fryżewska, Ewa Mrukwa-Kominek, Jerzy Chudek

Abstract

Objective: Management of Graves' orbitopathy remains a challenge. Our previous case report has shown promising results for rabbit antithymocyte globulin (rATG) in the treatment of Graves' orbitopathy.

Design: We present the response of 7 individuals with active moderate-to-severe steroid-resistant Graves' orbitopathy to rATG, representing preliminary results from a prospective single-center study.

Methods: rATG was administered intravenously at a dose of 0.8-1.0 mg/kg daily (cumulative dose of 150-200 mg). The primary outcome measures at weeks 24 and 48 were ≥2-point reduction in Clinical Activity Score from baseline, a proptosis response, a diplopia response, and improvement of distant best-corrected visual acuity and mean retinal sensitivity. Key secondary outcomes included stabilization of ganglion cell complex thickness, a decrease of retinal nerve fiber layer in OCT, and a reduction in CD4/CD8 ratio and TRAb at 48 weeks.

Results: An improvement in clinical activity score was observed in all patients, with disease inactivation in 3 cases. Proptosis reduction equal to or greater than 2 mm was noted for 8 of 10 eyes. Diplopia improved in three of 6 patients. There was an improvement in best-corrected visual acuity (from 0.69 to 0.78) and mean retinal sensitivity (from 20.8 to 23.5 dB). In addition, there was a long-lasting improvement in CD4/CD8 ratio in 6 patients. Two patients experienced adverse events (influenza and serum sickness).

Conclusion: rATG therapy offers a long-lasting improvement in moderate-to-severe steroid-resistant Graves' orbitopathy with improvement in functional vision (reduction of diplopia, improvement of visual acuity, retinal sensitivity, and VEP pattern). The therapy is well-tolerated.

Clinical trial registration: ClinicalTrials.gov, identifier NCT05199103.

Keywords: Graves’ disease; Graves’ orbitopathy; antithymocyte globulin; proptosis; thyroid eye disease.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Sarnat-Kucharczyk, Świerkot, Handzlik, Kulawik, Jagoda, Grochoła-Małecka, Fryżewska, Mrukwa-Kominek and Chudek.

Figures

Figure 1
Figure 1
The graphs show (A) mean best-corrected visual acuity (BCVA), (B) mean retinal sensitivity, (C) mean retinal nerve fiber layer (RNFL) – at baseline and at 6, 12, 24, 48 weeks after treatment. *P < 0.05 vs. baseline measurement.

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Source: PubMed

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