Tello-Winniczuk N, Díaz-Jouanen E

Idioma: Español
Referencias bibliográficas: 35
Paginas: 536-543
Archivo PDF: 142.32 Kb.

RESUMEN

La enfermedad de Graves es la causa más frecuente de hipertiroidismo, afectando principalmente a mujeres jóvenes y con una etiología de base autoinmune. Una de sus manifestaciones es la oftalmopatía, cuya fisiopatología se desconoce. Ésta representa uno de los mayores retos terapéuticos en estos pacientes, ya que requieren de tratamientos agresivos con esteroides y múltiples cirugías reconstructivas subsecuentes en algunos casos, además del alto costo que representa lo anterior al sistema de salud. Los fármacos dirigidos a la depleción de células B han resultado muy efectivos para varias enfermedades autoinmunes. El rituximab es un anticuerpo monoclonal murino humanizado contra células CD20+ que está siendo estudiado actualmente en diversas enfermedades autoinmunes, entre ellas la enfermedad de Graves. El objetivo de este trabajo es exponer los posibles mecanismos por los que el rituximab pudiera actuar en la enfermedad de Graves, tanto en hipertiroidismo como en oftalmopatía, así como la experiencia que se tiene hasta ahora en este sentido. El uso de rituximab en pacientes de reciente inicio o con manifestaciones de oftalmopatía leve es cuestionable con la evidencia disponible hasta ahora; sin embargo, se considera que puede tener un papel en casos refractarios o con contraindicación para el uso de esteroides.

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