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The treatment outcomes in IgG4‐related orbital disease: a systematic review of the literature
Author(s) -
Detiger Sanne E.,
Karim A. Faiz,
Verdijk Robert M.,
van Hagen P. Martin,
van Laar Jan A. M.,
Paridaens Dion
Publication year - 2019
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/aos.14048
Subject(s) - rituximab , medicine , igg4 related disease , systematic review , medline , disease , abatacept , surgery , lymphoma , political science , law
IgG4‐related disease (IgG4‐ RD ) is an immune‐mediated systemic fibro inflammatory disease. Treatment of IgG4‐related orbital disease (IgG4‐ ROD ) is often indicated to relieve the symptoms and to prevent complications. For IgG4‐ ROD , no international formal treatment guidelines are available and the optimal treatment strategy is uncertain. In this systematic review, we describe the efficacy of conventional and biologic disease‐modifying antirheumatic drugs ( DMARD s) in IgG4‐ ROD . A systematic search of Embase, Medline, Web‐of‐Science, PubMed publisher, Cochrane and Google Scholar was performed for treatment outcomes in IgG4‐ ROD . Relevant articles on treatment of IgG4‐ ROD were retrieved to last date of inclusion 3 January 2018. The following inclusion criteria were used: articles in English or English translation, studies evaluating the use of DMARD s (conventional and biologic) in the treatment of IgG4‐ ROD . Meta‐analysis and review articles were excluded. A final selection after full‐text evaluation was made by independent reviewers, based on treatment of IgG4‐ ROD with DMARD s and the availability of treatment outcomes. With this systematic review, we identified 35 studies and case reports/series on IgG4‐ ROD , describing 95 patients, treated with conventional and/or biologic DMARD s. The success of conventional DMARD s varies between 36% and 75% in patients with IgG4‐ ROD , while rituximab is successful in the majority (93%) of the patients. Based on this systematic review, rituximab is the most effective DMARD in IgG4‐ ROD , while the efficacy of conventional DMARD s is limited. We propose early initiation of rituximab in case of refractory and organ‐ or life‐threatening disease.