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. 2024 Mar;38(4):723-729.
doi: 10.1038/s41433-023-02758-8. Epub 2023 Sep 25.

Successful remission induction of IgG4-related ophthalmic disease by obinutuzumab therapy: a retrospective study of 8 patients

Hetian Sun  1 , Xueying Zeng  1 , Yang Li  1 , Hang Li  1 , XinLei Yao  1 , Yu Xue  1 , Wei Lu  2
Affiliations

Successful remission induction of IgG4-related ophthalmic disease by obinutuzumab therapy: a retrospective study of 8 patients

Hetian Sun et al. Eye (Lond). 2024 Mar.

Abstract

Objectives: To evaluate the therapeutic efficacy and safety of obinutuzumab in remission induction for IgG4-related ophthalmic disease (IgG4-ROD) patients.

Methods: Eight IgG4-ROD patients were retrospectively enrolled. They were intravenously administered 1000 mg obinutuzumab at baseline and examined for changes in physical signs, orbital structure imaging parameters, IgG4-related disease responder index (IgG4-RD RI), serological index, and adverse events during treatment. The number of treatment sessions was based on treatment response.

Results: The mean IgG4-RD RI scores of all patients at baseline (7.75 ± 2.92) and after treatment (2.00 ± 0.76) were highly significantly different (P < 0.001). Six patients achieved complete remission (CR) (75%) and two patients achieved partial remission (25%). The mean serum IgG4 levels at baseline (9.45 ± 6.95 g/L) and after treatment (1.55 ± 1.09 g/L) showed a mean decrease of 83% (P = 0.0079). The serum IgG4 level correlated well with IgG4-RD RI at baseline and that after each treatment (r = 0.852, P < 0.01; r = 0.78, P < 0.001). In patients with CR, the serum IgG4 levels at baseline correlated positively with dose numbers required for CR (r = 0.86, P < 0.05). Five patients (62.5%) experienced infusion-related reactions (IRRs) during the first obinutuzumab infusion, while only one (12.5%) experienced IRRs during all subsequent eight infusions.

Conclusion: Obinutuzumab is a safe and promising therapeutic option for IgG4-ROD. It rapidly reduces ocular inflammation and serum IgG4 levels to avoid excessive corticosteroid usage and reduce potential risk of adverse events.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Evaluation of ocular disease activity based on physical examination and imaging.
A Changes in appearance of case 4 during treatment course. B Changes in the size of lacrimal gland based on coronal scan before and after treatment in case 5. C Changes in the largest short diameter of the extraocular muscle involved in inflammation and in the size of lesions for infraorbital nerve and maxillary sinus in case 1.
Fig. 2
Fig. 2. Changes in two key parameters reflecting the effectiveness of the therapy.
A Changes of IgG4-RD RI in 8 patients during treatment course. B Changes of serum IgG4 level in 8 patients during treatment course.
Fig. 3
Fig. 3. Correlation between serum IgG4 level and ocular disease activity.
A The linear correlation showing a higher baseline serum IgG4 level leading to a higher baseline RI and a higher number of doses to achieve CR. B The linear correlation between serum IGg4 and IgG4-RD RI after each treatment.
See this image and copyright information in PMC

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References

    1. Saitakis G, Chwalisz BK. The neurology of IGG4-related disease. J Neurol Sci. 2021;424:117420. doi: 10.1016/j.jns.2021.117420. - DOI - PubMed
    1. Stone JH, Zen Y, Deshpande V. IgG4-related disease. N Engl J Med. 2012;366:539–51. doi: 10.1056/NEJMra1104650. - DOI - PubMed
    1. Derzko-Dzulynsky L. IgG4-related disease in the eye and ocular adnexa. Curr Opin Ophthalmol. 2017;28:617–22. doi: 10.1097/icu.0000000000000427. - DOI - PubMed
    1. McNab AA, McKelvie P. IgG4-related ophthalmic disease. Part II: clinical aspects. Ophthalmic Plast Reconstr Surg. 2015;31:167–78. doi: 10.1097/iop.0000000000000364. - DOI - PubMed
    1. Wallace ZS, Deshpande V, Stone JH. Ophthalmic manifestations of IgG4-related disease: single-center experience and literature review. Semin Arthritis Rheum. 2014;43:806–17. doi: 10.1016/j.semarthrit.2013.11.008. - DOI - PubMed

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