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Klin Monbl Augenheilkd 2024; 241(01): 48-68
DOI: 10.1055/a-2186-5548
DOI: 10.1055/a-2186-5548
Übersicht
Current Therapeutic Approaches for Gravesʼ Orbitopathy – are Targeted Therapies the Future?
Article in several languages: deutsch | English
Abstract
Gravesʼ orbitopathy is an autoimmune disease of the orbit that most frequently occurs with Gravesʼ hyperthyroidism. The occurrence of autoantibodies directed against the TSH receptor (TRAb) is of central importance for the diagnosis and pathogenesis. These autoantibodies are mostly stimulating, and induce uncontrolled hyperthyroidism and tissue remodelling in the orbit and more or less pronounced inflammation. Consequently, patients suffer to a variable extent from periocular swelling, exophthalmos, and fibrosis of the eye muscles and thus restrictive motility impairment with double vision. In recent decades, therapeutic approaches have mainly comprised immunosuppressive treatments and antithyroid drug therapy for hyperthyroidism to inhibit thyroid hormone production. With the recognition that TRAb also activates an important growth factor receptor, IGF1R (insulin-like growth factor 1 receptor), biological agents have been developed. Teprotumumab (an inhibitory IGF1R antibody) has already been approved in the USA and the therapeutic effects are enormous, especially with regard to the reduction of exophthalmos. Side effects are to be considered, especially hyperglycaemia and hearing loss. It is not yet clear whether the autoimmune reaction (development of the TRAb/attraction of immunocompetent cells) is also influenced by anti-IGF1R inhibiting agents. Recurrences after therapy show that the inhibition of antibody development must be included in the therapeutic concept, especially in severe cases.
Key words
Gravesʼ orbitopathy - pathogenesis - risk factors - guidelines - targeted therapies - clinical classificationPublication History
Received: 08 July 2023
Accepted: 05 October 2023
Accepted Manuscript online:
05 October 2023
Article published online:
19 January 2024
© 2024. Thieme. All rights reserved.
Georg Thieme Verlag KG
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