Objective To explore the efficacy of rituximab (RTX) orbital injection combined with intravenous drip of methylprednisolone in treating Graves' ophthalmopathy.
Methods A total of 102 patients with Graves' ophthalmopathy in the Ziyang City People's Hospital from July 2021 to January 2023 were randomly divided into combination group (n=34), methylprednisolone group (n=34), and RTX group (n=34). The methylprednisolone group was given glucocorticoids (methylprednisolone) monotherapy, the RTX group was given RTX monotherapy, and the combination group was given RTX combined with methylprednisolone. The total effective rate, ophthalmic manifestations, thyroid volume, thyroid immune antibodies thyroid globulin antibody (TGAb), thyrotropin receptor antibody (TRAb) and thyroid peroxidase antibody (TPOAb) levels, the Clinical Activity Scale (CAS), levels of immunoglobulins in peripheral blood immunoglobulin G4 (IgG4) and IgG4/IgG, and adverse reactions were compared among the three groups.
Results The total effective rate was 97.06%(33/34) in the combination group, which was significantly higher than 79.41%(27/34) in the methylprednisolone group and 76.47%(26/34) in the RTX group (P < 0.05). After 4 and 8 weeks of treatment, the exophthalmos degree, interocular distance, intraocular pressure, and retrobulbar soft tissue volume in the combination group were significantly lower than those in the methylprednisolone group and the RTX group (P < 0.05); the thyroid volume and the CAS score in the combination group were significantly lower than those in the methylprednisolone group and the RTX group (P < 0.05); the TGAb, TRAb and TPOAb levels in the combination group were significantly lower than those in the methylprednisolone group and the RTX group (P < 0.05); the IgG4 and IgG4/IgG in the combination group were significantly lower than those in the methylprednisolone group and the RTX group (P < 0.05). There was no significant difference in the incidence of adverse
Conclusions For patients with Graves' ophthalmopathy, therapeutic effect of RTX orbital injection combined with intravenous drip of methylprednisolone is better, which is beneficial for improving ophthalmic manifestations and regulating levels of TGAb, TRAb, TPOAb and immunoglobulins.
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