Ciclosporine and Graves’ Ophthalmopathy

Abstract

The pharmacological treatment of Graves’ ophthalmopathy remains unsatisfactory due to the limited efficacy and severe side effects of the available drugs. Ciclosporine, an immunosuppressive drug has recently been used with the aim of controlling the autoimmune process considered to be responsible for the disease. This paper reviews the data obtained with ciclosporine in comparison with those previously reported with corticosteroids.

Results of a neurosurgical two‐wall orbital decompression in the treatment of severe thyroid associated ophthalmopathy

“…First and foremost meticulous control of the thyroid function, second, immunosuppressive treatment (corticosteroids, cyclosporine) or orbital irradiation (Prummel & Wiersinga 1995; Bartalena et al 1983, 1998). Response to immunosuppression on soft tissue involvement is seen in around 2/3 of the patients (Gayno & Strauch 1987), but the effect on proptosis and visual acuity is limited (Burch & Wartofsky 1993). The effect of orbital irradiation is similar (Bartalena et al 1983) although often delayed for more than a year (Claridge et al 1997).…”

Therapeutic Outcome of Prednisone Medication and of Orbital Irradiation in Patients with Graves’ Ophthalmopathy

“…Also, as has been the expe rience of others, it is not unusual that some of the benefit gained from the steroid medica tion is lost upon reduction of the prednisone dose below 20mg [5], The response to pred nisone was observed in all classes of the NOS PECS system as indicated by a general shift to lower grades in each class ( fig. 2).…”

“…The reports differ considera bly with respect to: (1) dose and duration of prednisone medication, (2) patient selection; (3) time of evaluation; (4) criteria for asses sing therapeutic outcome, and (5) complete ness of ophthalmological investigation. Nev ertheless, from the combined results of oral corticosteroid therapy in 81 patients with Graves' ophthalmopathy as summarized from 5 papers by Gayno and Strauch [5], it can be calculated that 68% did respond to steroids and 32% did not. This is remarkably similar to the 66% responders and 34% non responders to prednisone in this study.…”