Infliximab Treatment of Refractory Thyroid Associated Orbitopathy

Abstract

Abstract: : Purpose: To assess the efficacy and safety of the anti–tumor necrosis factor alpha agent infliximab in the treatment of resistant thyroid associated orbitopathy (TAO). Methods: In this retrospective, noncomparative, interventional case series, three patients with TAO that was refractory to standard treatment protocols underwent infliximab therapy. Infusions of infliximab, 10 mg/kg were given at 4–week to 8–week intervals, depending on the clinical response. The main outcome measure was the clinical response, which included subjective improvment in pain, pressure, diplopia, and visual acuity. Results: Three patients between the ages of 37 and 55 with a history of TAO, refractory to other treatments underwent infliximab infusions 10 mg/kg IV every week every one eight weeks combined with either methotrexate (2 patients) or cyclophosphamide (1 patient). All patients reported a subjective improvement in symptoms, namely pressure and irritation. Conclusions: Infliximab seemed to be effective and safe as a rescue therapy in this small series of patients with refractory thyroid associated orbitopathy . Further investigation is warranted.

Keywords: orbit • inflammation • immunomodulation/immunoregulation