Beneficial effects of intensive plasma exchange followed by immunosuppressive therapy in severe Graves' ophthalmopathy

Glinoer, Daniel; Etienne-Decerf, J; Schrooyen, Marc; Sand, Georges; Hoyoux, P; Mahieu, P.; Winand, René

doi:10.1530/acta.0.1110030

Cited by 50 publications

(22 citation statements)

References 13 publications

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“…The patients were submitted to 4 plasmapheresis sessions over a period of 5-8 days and were subsequently treated for 3-6 months with a combination of prednisolone and azathioprine; three patients had a recurrence of ophthalmopathy 1 yr after treatment, requiring a second course of plasmapheresis (153). Favorable results were also reported by Berlin et al (154), who observed a reduction of the OI in 9 (69%) and of subjective symptoms in 10 (77%) of 13 patients; azathioprine was concomitantly administered to 8 patients, and 2 patients needed further sessions of plasmapheresis.…”

Section: Plasmapheresismentioning

confidence: 99%

Management of Graves' Ophthalmopathy: Reality and Perspectives

Bartalena¹

2000

Endocrine Reviews

299

351

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Graves' ophthalmopathy is an debilitating disease impairing the quality of life of affected individuals. Despite recent progress in the understanding of its pathogenesis, treatment is often not satisfactory. In mild cases, local therapeutic measures (artificial tears and ointments, sunglasses, nocturnal taping of the eyes, prisms) can control symptoms and signs. In severe forms of the disease (3-5%), aggressive measures are required. If the disease is active, high-dose glucocorticoids and/or orbital radiotherapy, or orbital decompression represent the mainstay of treatment. If the disease is severe but inactive, orbital decompression is preferred. Novel treatments such as somatostatin analogs or intravenous immunoglobulins are under evaluation. Rehabilitative (extraocular muscle or eyelid) surgery is often needed after treatment and inactivation of eye disease. Correction of both hyper-and hypothyroidism is crucial for the ophthalmopathy. Antithyroid drugs and thyroidectomy do not influence the course of the ophthalmopathy, whereas radioiodine treatment may cause the progression of preexisting ophthalmopathy, especially in smokers. The exacerbation, however, is prevented by glucocorticoids. In addition, thyroid ablation may prove beneficial for the ophthalmopathy in view of the pathogenetic model relating eye disease to autoimmune reactions directed against antigens shared by the thyroid and the orbit.

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Section: Plasmapheresismentioning

confidence: 99%

Management of Graves' Ophthalmopathy: Reality and Perspectives

Bartalena¹

2000

Endocrine Reviews

299

351

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“…It is considered that the present therapy was more effective than others [14]. Although extraocular muscle dysfunction in particular has been considered to be refractory to other therapies [5,10,27,32], it is reported that 60% [18] or 75% [20] of patients showed a loss of diplopia with steroid pulse therapy.…”

Section: Resultsmentioning

confidence: 89%

“…TAO seems to be caused by an autoimmune mechanism related to the thyroid [2][3][4]. Various immunosuppressive therapies have been reported, including systemic steroids [5], retrobulbar steroids [6], azathioprine [7], cyclophosphamide [8], cyclosporine [9,10], plasmapheresis [11,12], high-dose immunoglobulin [13] and combinations thereof [14,15]. Although high-dose systemic corticosteroids, e. g. prednisolone 80-100 mg daily, have been used with some success, there is a high tendency to relapse as the steroid doses are reduced and often maintenance levels of 30 mg per day or more are needed, which leads an increase in the frequency and severity of adverse effects [16].…”

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confidence: 99%

High-Dose Intravenous Steroid Pulse Therapy in Thyroid-Associated Ophthalmopathy.

et al. 1996

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Abstract. To evaluate the efficacy of high-dose intravenous steroid pulse followed by oral steroids in the treatment of thyroid-associated ophthalmopathy, we performed clinical assessment and measurement of retroorbital muscle enlargement in 27 patients before and after the therapy, and followed them up longitudinally.The mean duration of follow up is (mean ± SD) 29.8 ± 23.8 months (range 4-92). Diplopia disappeared in 10 patients and ameliorated in 11 patients. The degree of proptosis decreased in 15 patients and the fall in visual acuity improved in a third of the patients. The total ophthalmopathy index (01) decreased from 7.0 ± 1.9 to 3.0 ± 1.5. The extraocular muscle enlargement (EME), expressed as the maximal ratio of extraocular muscle thickness to the diameter of the optic nerve, decreased from 2.33 ± 0.56 to 1.27 ± 0.26. No major side effects were found in any patient. The improvement in the eye disease was found immediately after the pulse therapy, prior to the start of the following therapy by oral steroids and/or orbital irradiation. Both of OI and EME decreased with time after the therapy and did not get worse after withdrawing oral steroids. The efficacy of the therapy evaluated by degrees of improvement in 01 and in EME was significantly greater in females than in males. Although there was a significant positive correlation between initial OI and EME values and initial TBII and TSAb activities, a significant correlation was seen only between the degrees of improvement in EME and changes in TBII activity due to the therapy. The duration of eye disease, thyroid status, treatment with anti-thyroid drug, smoking and experience of previous treatment did not affect the efficacy of the present therapy. We conclude that high-dose intravenous steroid pulse therapy is effective and safe for thyroid-associated ophthalmopathy.

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“…In our case, for example, the best response to TPE was in a patient with a non-autoimmune disease. The success of TPE in this case was attributed to the dilution of hormones and the generation of free proteins with new binding sites, which reduced their free fractions and thus their biological activity [15][16][17][18][19][20][21]. While this is effective in the short-term, its effect is transient and so TPE cannot be used as definitive therapy.…”

Section: Discussionmentioning

confidence: 99%