Endocrine Abstracts

JOINT235

Background: Graves’ disease (GD) frequently recurs following the cessation of anti-thyroid drugs (ATDs), particularly in patients with concomitant Graves’ orbitopathy (GO), which poses additional therapeutic challenges. This clinical epidemiological study aimed to evaluate the efficacy of intravenous methylprednisolone (IVMP) therapy alone or in combination with rituximab (RTX) in achieving long-term remission of GD in patients with moderate-to-severe and active GO.

Methods: This study involved a cohort of 52 patients with moderate-to-severe and active GO treated at the National Taiwan University Hospital from 2008 to 2023. Patients who received IVMP or RTX in addition to IVMP for the treatment of GO were enrolled. Demographic and clinical data, thyroid function tests, and thyroid autoantibodies were collected. The primary outcome measured was the time to remission from GD, defined as the maintenance of euthyroidism for more than 12 months after stopping the antithyroid drug.

Results: Among the 52 patients, 35 were treated with only IVMP and 17 with RTX after IVMP. The RTX group demonstrated a significantly higher remission rate compared to the IVMP group (58.8% vs. 17.1%, P = 0.002). The Kaplan-Meier curve revealed an evident likelihood of the RTX group on the rate of GD remission (log-rank test, P=0.0086). Multivariate analysis identified several predictors of remission, including RTX use with thyrotropin-binding inhibitory immunoglobulin (TBII) levels less than 88%, BMI within the range of 19.7 and 24.1, and the age of IVMP initiation, highlighting the potential benefits of RTX therapy in this context.

Conclusions: The addition of RTX to IVMP for patients with moderate-to-severe GO significantly increases the likelihood of achieving and sustaining remission of GD, particularly in those with TBII levels less than 88%. These findings suggested that incorporating RTX into the therapeutic protocol for patients with GO could be a valuable strategy to improve long-term disease control and achieve remission of GD.