A Prospective, Randomized Trial of Intravenous Glucocorticoids Therapy With Different Protocols for Patients With Graves' Ophthalmopathy

Zhu, Wei; Ye, Lei; Shen, Liyun; Qin, Jiao; Huang, Felix C.; Han, Rulai; Zhang, Xiaofang; Shu, Wang; Wang, Weiqing; Ning, Guang

doi:10.1210/jc.2013-3919

Cited by 95 publications

(104 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…To the best of our knowledge, there were 2 randomized clinical trials investigating the optimal dose and schedule of iv GC therapy [16,17]. When Bartalena et al compared the safety and efficacy of 3 low-dose iv GC regimens (cumulative doses of 2.25 g, 4.98 g, and 7.47 g), they concluded that the higher-dose regimen provided a short-term advantage in efficacy, but had slightly greater toxicity [16].…”

Section: Discussionmentioning

confidence: 99%

“…Since this is not a standard method for comparing SIRs from different MRI scanners, this approach requires further verification. We did not define the outcome of GO by evaluating a combination of changes in ophthalmic parameters because we were not able to collect complete information about ophthalmic parameters that were evaluated in prior large prospective studies [16,17]. For example, we were not able to obtain grades in each class of the NOSPECS classification from the patients' medical records.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Overall safety and efficacy of high-dose and low-dose intravenous glucocorticoid therapy in patients with moderate-to-severe active Graves’ ophthalmopathy

et al. 2016

View full text Add to dashboard Cite

Abstract. The objective of this study was to compare the safety and efficacy of high-dose and low-dose intravenous (iv) glucocorticoid (GC) therapy in patients with Graves' ophthalmopathy (GO) and to investigate which factors may help determine appropriate iv GC doses. The medical records of 43 patients who received different doses of iv GCs for GO were retrospectively reviewed. Twenty patients received high-dose iv GCs (HD group, cumulative dose 9.0-12.0 g) and 18 received low-dose iv GCs (LD group, cumulative dose 4.5 g). Five patients with previous treatment for GO were excluded. Changes in ophthalmic parameters after treatment and frequencies of adverse effects due to GCs of the 2 groups were compared. We also reviewed the incidence of GO progression and hepatic dysfunction after patients were discharged. We evaluated correlations among pretreatment (before treatment) ophthalmic parameters and investigated useful predictive factors for determining iv GC doses. There were no significant differences in ophthalmic parameters reflecting treatment efficacy or overall safety between the groups. Among baseline ophthalmic parameters, corrected signal intensity ratio (cSIR) correlated well with magnetic resonance imaging findings and were more strongly associated with changes in ophthalmic parameters after treatment in the HD group than in the LD group, indicating that pretreatment cSIR might be useful for determining iv GC doses. In conclusion, there were no significant differences in overall safety and efficacy between high-dose and low-dose iv GC therapy in patients with active GO. Further randomized clinical trials with longer observation periods are required to establish the optimal treatment regimen of GO.Key words: Graves' ophthalmopathy, Thyroid-associated ophthalmopathy, Intravenous glucocorticoid therapy, MRI, STIR Since GO is generally considered an autoimmune disorder, glucocorticoid (GC) therapy has been used for GO for the last few decades. Different routes of administration and dosages have been used, and various studies have attempted to identify the optimal regimen Original ©The Japan Endocrine Society Submitted Jan. 20, 2016; Accepted May 10, 2016 as EJ16-0038 Released online in J-STAGE as advance publication Jun. 5, 2016 Correspondence to: Naotetsu Kanamoto, M.D., Ph.D., Department of Endocrinology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan. E-mail: kyotetsu@kuhp.kyoto-u.ac.jp * Current affiliation Abbreviations: GO, Graves' ophthalmopathy; GD, Graves' disease; GC, glucocorticoid; iv, intravenous; mPSL, methylprednisolone; EUGOGO, European Group on Graves' Orbitopathy; MRI, magnetic resonance imaging; CAS, Clinical Activity Score; SIR, signal intensity ratio; PSL, prednisolone; CAS, clinical activity score; STIR, short tau inversion recovery; T1W, T1-weighted; ROIs, regions-of-interest; cSIR, corrected SIR; ANCOVA, analysis of covariance. decreasing visual acuity; and one or more enlarged extraocular muscles with high intensity signals on T2-we...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Overall safety and efficacy of high-dose and low-dose intravenous glucocorticoid therapy in patients with moderate-to-severe active Graves’ ophthalmopathy

et al. 2016

View full text Add to dashboard Cite

show abstract

“…The efficacy and safety of different IV glucocorticosteroid therapy protocols are still under debate. Presently, there are no generally accepted recommendations or guidelines for treatment of GO [20,[34][35][36].…”

Section: Discussionmentioning

confidence: 99%

Wcześniejsze leczenie choroby Gravesa lekami tyreostatycznymi lub radiojodem nie wpływa na skuteczność leczenia immunosupresyjnego orbitopatii tarczycowej

Jagiełło-Korzeniowska¹,

Sokołowski

Krzentowska-Korek³

et al. 2016

Endokrynologia Polska

View full text Add to dashboard Cite

Introduction: We studied the efficacy of immunosuppressive treatment of GO in a group of patients who had been treated with antithyroid drugs (the ATD group) and in another group that had undergone radioiodine therapy (the 131-I group). Material and methods: A total of 214 patients with exacerbation of GO were studied; the ATD group consisting of 168 patients, and the 131-I group consisting of 46 patients. All patients were treated with methylprednisolone IV pulses (total dose 8.0 g) followed by orbital irradiation (20 Gy in 10 fractions). CAS and IO indices, TSH, fT4, and TRAb levels were evaluated prior to, and 1, 6, and 12 months after treatment.

show abstract

“…In a recent randomized study, this schedule was compared with a shorter regimen of the same cumulative dose (daily infusion of 0.5 g for 3 days over 2 weeks, followed by a daily infusion of 0.25 g for 3 days over 2 weeks) [69]. The latter protocol was, however, associated with lower efficacy compared to the standard protocol (response rate of 41 vs. 77%; p = 0.0025) and toxicity was higher [69].…”

Section: Recommendationsmentioning

confidence: 99%

The 2016 European Thyroid Association/European Group on Graves' Orbitopathy Guidelines for the Management of Graves' Orbitopathy

et al. 2016

View full text Add to dashboard Cite

Graves' orbitopathy (GO) is the main extrathyroidal manifestation of Graves' disease, though severe forms are rare. Management of GO is often suboptimal, largely because available treatments do not target pathogenic mechanisms of the disease. Treatment should rely on a thorough assessment of the activity and severity of GO and its impact on the patient's quality of life. Local measures (artificial tears, ointments and dark glasses) and control of risk factors for progression (smoking and thyroid dysfunction) are recommended for all patients. In mild GO, a watchful strategy is usually sufficient, but a 6-month course of selenium supplementation is effective in improving mild manifestations and preventing progression to more severe forms. High-dose glucocorticoids (GCs), preferably via the intravenous route, are the first line of treatment for moderate-to-severe and active GO. The optimal cumulative dose appears to be 4.5-5 g of methylprednisolone, but higher doses (up to 8 g) can be used for more severe forms. Shared decision-making is recommended for selecting second-line treatments, including a second course of intravenous GCs, oral GCs combined with orbital radiotherapy or cyclosporine, rituximab or watchful waiting. Rehabilitative treatment (orbital decompression surgery, squint surgery or eyelid surgery) is needed in the majority of patients when GO has been conservatively managed and inactivated by immunosuppressive treatment.

show abstract

A Prospective, Randomized Trial of Intravenous Glucocorticoids Therapy With Different Protocols for Patients With Graves' Ophthalmopathy

Abstract: The weekly protocol of iv methylprednisolone therapy is more efficient and safer than the daily protocol for patients with active moderate-to-severe GO.

Cited by 95 publications

References 28 publications

Overall safety and efficacy of high-dose and low-dose intravenous glucocorticoid therapy in patients with moderate-to-severe active Graves’ ophthalmopathy

Overall safety and efficacy of high-dose and low-dose intravenous glucocorticoid therapy in patients with moderate-to-severe active Graves’ ophthalmopathy

Wcześniejsze leczenie choroby Gravesa lekami tyreostatycznymi lub radiojodem nie wpływa na skuteczność leczenia immunosupresyjnego orbitopatii tarczycowej

The 2016 European Thyroid Association/European Group on Graves' Orbitopathy Guidelines for the Management of Graves' Orbitopathy

Contact Info

Product

Resources

About

A Prospective, Randomized Trial of Intravenous Glucocorticoids Therapy With Different Protocols for Patients With Graves' Ophthalmopathy

Abstract: The weekly protocol of iv methylprednisolone therapy is more efficient and safer than the daily protocol for patients with active moderate-to-severe GO.

Cited by 95 publications

References 28 publications

Overall safety and efficacy of high-dose and low-dose intravenous glucocorticoid therapy in patients with moderate-to-severe active Graves&rsquo; ophthalmopathy

Overall safety and efficacy of high-dose and low-dose intravenous glucocorticoid therapy in patients with moderate-to-severe active Graves&rsquo; ophthalmopathy

Wcześniejsze leczenie choroby Gravesa lekami tyreostatycznymi lub radiojodem nie wpływa na skuteczność leczenia immunosupresyjnego orbitopatii tarczycowej

The 2016 European Thyroid Association/European Group on Graves' Orbitopathy Guidelines for the Management of Graves' Orbitopathy

Contact Info

Product

Resources

About

Overall safety and efficacy of high-dose and low-dose intravenous glucocorticoid therapy in patients with moderate-to-severe active Graves’ ophthalmopathy

Overall safety and efficacy of high-dose and low-dose intravenous glucocorticoid therapy in patients with moderate-to-severe active Graves’ ophthalmopathy