PURPOSE OF REVIEW: In recent years, immunosuppressive therapy, as an alternative 
to corticosteroids, has been proposed as novel agents which target the various 
antigens involved in the pathogenesis of Graves' ophthalmopathy. Although the 
lack of randomized and controlled studies suggests caution in generalizing 
results, some data show interesting results.
RECENT FINDINGS: Potential targets for immune therapy in Graves' ophthalmopathy 
are the antigens expressed on the target organ of inflammation, namely the 
receptor and the insulin growth factor -1 receptor on fibroblasts, inflammatory 
cytokines, and B and T cells. The most promising results are observed with small 
thyroid stimulating hormone receptor molecules interacting with the receptor on 
thyrocytes and fibroblasts and with the anti-IGF-1 receptor antibody 
teprotumumab. A recent open study with tocilizumab, an anti-soluble 
interleukin-6 receptor, has shown inactivation of Graves' ophthalmopathy. 
Consistent reports on the efficacy of rituximab will have to be confirmed by 
randomized controlled trials, which are now in progress.
SUMMARY: Current clinical practice for Graves' ophthalmopathy will greatly 
benefit from the availability of immunosuppressors that act as disease-modifying 
drugs, as compared to steroids, the current standard treatment for Graves' 
ophthalmopathy. Rituximab seems to be a good candidate, as preliminary results 
from ongoing randomized trials suggest good efficacy with a relative well 
tolerated profile.