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We evaluate the usefulness of clinical activity score (CAS) and thyroid-stimulating immunoglobulin (TSI) as predictors and\/or post-treatment markers of corticoresistance in patients with TED and the effect of rituximab in second-line treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We enrolled 236 patients with an active TED into this retrospective single-tertiary-center cohort study. All patients were initially treated with high-dose systemic glucocorticoids. Rituximab was later administered to 29 of 42 corticoresistant patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The CAS of the corticoresistant patients was significantly higher both before (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0001) and after (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009&lt;0.0001) first-line treatment compared to the corticosensitive group. ROC analysis established the cut-point value as CAS\u2009\u2265\u20092.5 with a sensitivity of 96.3%, specificity of 57.5% and area under the curve of 82.8%. In 22 patients treated with rituximab, CAS gradually decreased to zero values without reactivation during extended follow-up. There was no difference in the TSI of corticosensitive and corticoresistant patients before or after first-line therapy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CAS\u2009\u2265\u20092, after first-line treatment, could be used as a corticoresistance marker. Corticoresistant patients should be subject to long-term follow-up for early detection of reactivation to reduce the delay to second-line treatment. Rituximab is a well-tolerated choice of second-line treatment and has a long-lasting effect on disease activity. Although TSI is a valuable biomarker of Graves\u2019 disease and TED activity, according to our results, TSI cannot be used as a marker of corticoresistance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s12020-024-04108-4","type":"journal-article","created":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T22:52:44Z","timestamp":1732747964000},"page":"1112-1119","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Evaluation of corticoresistance in patients with thyroid eye disease and use of rituximab as a second-line treatment"],"prefix":"10.1007","volume":"87","author":[{"given":"Klara","family":"Pekarova","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Schovanek","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roman","family":"Dohnal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr","given":"Martin","family":"Radvansky","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Karasek","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Karhanova","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,11,28]]},"reference":[{"key":"4108_CR1","doi-asserted-by":"publisher","unstructured":"G. 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The study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of University Hospital Olomouc (Ref. No. 49\/23). Consent to publish: The authors affirm that human research participants provided informed consent for publication of the images in Suplementary Fig.\n                      \n                      .","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}