Comparative effectiveness of different treatment modalities for active, moderate‐to‐severe Graves' orbitopathy: a systematic review and network meta‐analysis

Li, Hongxun; Yang, Lihong; Song, Yi; Zhao, Xinheng; Sun, Chunhua; Zhang, Lei; Zhao, Hong; Pan, Ye

doi:10.1111/aos.15074

Cited by 4 publications

(3 citation statements)

References 59 publications

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“…Several recent articles have pointed out this lack of direct comparison between Mabs and more traditional forms of therapy such as intravenous steroids associated with radiotherapy. [104][105][106][107] In fact, in the few randomized clinical trials, the effect of the Mab has been compared only to placebos 44,52,66 or steroids alone. 42,43,47,81 One relevant question is to identify who are the patients that need to undergo immunotherapy.…”

Section: Discussionmentioning

confidence: 99%

Monoclonal Antibodies for the Treatment of Graves Orbitopathy: Precision Medicine?

Xavier

Lucena

Cruz

2023

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose: To summarize the development, nomenclature, and rationale of the reported use of monoclonal antibodies (Mabs) in Graves Orbitopathy (GO) and to undertake a systematic review of the management of GO with Mabs. Methods: The Pubmed and Embase databases and the Federal Brazilian searching site (Periódicos-CAPES) were screened. The authors searched all the keywords “monoclonal antibodies,” “adalimumab,” “belimumab,” “infliximab,” “rituximab,” “teprotumumab,” and “tocilizumab” combined with the terms “Graves Orbitopathy,” “Graves eye disease” and “thyroid eye disease.” All the articles published in English, French, and Spanish from 2000 to May 2022 were screened. Only publications with quantitative data on the activity of orbitopathy, proptosis, or both were included. Results: Seventy-six articles of the 954 screened records met the inclusion criteria. Seven Mabs were described for treating GO. The three most reported Mabs were Rituximab, Tocilizumab, and Teprotumumab. Only eight randomized clinical trials compared the effect of these three Mabs and Belimumab with the effect of steroids or placebos. Adalimumab, Infliximab, and K1-70 only appeared in a few case series and case reports. Frequent mild-to-moderate and few major side effects occurred with the three most used Mabs. Relapse rates ranged from 7.4% for Tocilizumab to at least 29.4% for Teprotumumab. No randomized clinical trials compared Mabs head-to-head. Conclusion: Considering the lack of head-to-head comparisons between Mabs, the relapse rate, the possibility of severe collateral effects, and the cost of Mabs, it is not clear which Mab is the safest and most useful to treat GO.

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Section: Discussionmentioning

confidence: 99%

Monoclonal Antibodies for the Treatment of Graves Orbitopathy: Precision Medicine?

Xavier

Lucena

Cruz

2023

Ophthalmic Plastic &Amp; Reconstructive Surgery

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“…Using direct and indirect comparisons, treatment efficacies of all available treatments can be ranked according to a pre‐defined group, such as non‐treatment control, if it is possible to draw a complete network between treatment modalities (Subhi et al, 2022). This method of evidence synthesis has allowed more comprehensive reviews of treatment efficacies, where multiple treatments exist for different diseases in ophthalmology (Bicket et al, 2021; Fallico et al, 2021; Ha et al, 2022; Halili et al, 2020; Li et al, 2021; Rasmussen et al, 2022). For the case of cCSC, network meta‐analyses potentially allow comparison between different treatment modalities to the natural disease course without treatment.…”

Section: Introductionmentioning

confidence: 99%

Comparative efficacy of treatments for chronic central serous chorioretinopathy: A systematic review with network meta‐analyses

Dijk

Feenstra

Bjerager

et al. 2022

Acta Ophthalmologica

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Treatment of chronic central serous chorioretinopathy (cCSC) remains a topic of controversy. As cCSC is a disease that can wax and wane, treatment efficacy is difficult to assess especially when trials compare active treatments without any placebo/control group. In this study, we systematically reviewed short‐term efficacies of any cCSC treatment tested in randomized controlled trials (RCT) and employed network meta‐analyses to compare to non‐treatment controls. We searched 11 literature databases on 20 March 2022 for RCTs of treatment of cCSC. We identified 17 RCTs including a total of 1172 eyes. Treatments included conventional laser (44 eyes), half‐dose or half‐fluence photodynamic therapy (PDT) (298 eyes), ranibizumab (16 eyes), antioxidants (50 eyes), mineralocorticoid receptor antagonists (187 eyes), rifampicin (91 eyes), selective retina therapy (SRT) (67 eyes) and subthreshold micropulse laser (192 eyes). Compared with controls, significant benefit on complete subretinal fluid resolution was only obtained from half‐dose or half‐fluence PDT (OR: 20.6; 95% CI: 6.3–66.7; p < 0.0001) and conventional laser (OR: 36.4; 95% CI: 2.0–655.7; p = 0.015), and at an order of magnitude lower degree from SRT (OR: 3.4; 95% CI: 1.7–6.8; p = 0.00075). Compared with controls and after sensitivity analyses, significant benefit in the change in best‐corrected visual acuity was only obtained by half‐dose/‐fluence PDT (−0.13 logMAR; 95% CI: −0.20 to −0.06 logMAR; p = 0.00021). In conclusion, three treatment options provide significant improvement over no treatment: half‐dose/‐fluence PDT, conventional laser and to a much lesser degree SRT. Considering that conventional laser can only be applied for extrafoveal leaks, and the long‐term data available for PDT‐based treatments finding persisting treatment results, half‐dose or half‐fluence PDT is the only viable treatment option for patients with cCSC. Shortage issues with verteporfin should not lead to employment of ineffective treatment modalities, as they put patients at unnecessary risk of adverse events.

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“…8,9 Teprotumumab has demonstrated an important role in treatment of TED. [10][11][12][13][14][15][16] However, much remains unknown regarding its effects on diplopia outcomes among patients with TED. Previous studies have reported the effect of teprotumumab on diplopia subjectively using the Gorman diplopia scale.…”

mentioning

confidence: 99%

Objective Diplopia Outcomes for Patients Treated With Teprotumumab for Thyroid Eye Disease

Mudalegundi,

Huang,

Henderson

et al. 2023

Journal of Neuro-Ophthalmology

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Background: Thyroid eye disease (TED) is a condition caused by inflammatory damage to the periocular tissue that often leads to double vision. Teprotumumab is an insulin-like growth factor 1 receptor antibody that was FDA approved for the management of TED in 2020, although much is yet to be elucidated regarding its effects on diplopia outcomes among patients with TED. Diplopia is a significant and life-altering effect of TED. Previous studies have reported the effect of teprotumumab on double vision subjectively using the Gorman diplopia score. However, there is a gap in the literature addressing the effect of teprotumumab treatment on objective ocular alignment measures. The purpose of our study was to address this gap. Methods: We performed a retrospective review of patients who were diagnosed with TED, presented with diplopia, and treated with teprotumumab in a single-center academic ophthalmology practice. The primary outcome was change in ocular alignment in primary gaze position at 6 months (completion of teprotumumab treatment). Secondary outcomes included change in ocular alignment in other gaze positions, proptosis, eyelid position, and clinical activity score (CAS) at 6 months compared with baseline. To determine what factors may predict ocular alignment response to teprotumumab, we analyzed baseline characteristics among 3 groups, divided based on whether ocular alignment was worsened, stable, or improved at 6 months. Results: Seventeen patients met inclusion criteria, 3 (18%) worsened, 10 (59%) were stable, and 4 (24%) improved. CAS (P = 0.02) was significantly different among the groups and was higher in those who worsened and those who improved compared with those who remained stable. Right gaze horizontal prism deviation (P = 0.01) and left gaze horizontal prism deviation (P = 0.03) were significantly different among the groups, with a greater degree of left gaze horizontal prism deviation in the worse group than the stable group (P = 0.04). Conclusions: Our study demonstrated that most patients remained stable after teprotumumab treatment regarding ocular alignment in primary gaze and the number of patients who improved was slightly higher than the number of patients who worsened after teprotumumab treatment. There are some baseline measures, such as CAS and right and left gaze horizontal prism deviation that can help better predict how a patient will respond to teprotumumab treatment. Our results can better inform physicians of how to counsel patients with TED when considering teprotumumab therapy.

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Comparative effectiveness of different treatment modalities for active, moderate‐to‐severe Graves' orbitopathy: a systematic review and network meta‐analysis

Cited by 4 publications

References 59 publications

Monoclonal Antibodies for the Treatment of Graves Orbitopathy: Precision Medicine?

Monoclonal Antibodies for the Treatment of Graves Orbitopathy: Precision Medicine?

Comparative efficacy of treatments for chronic central serous chorioretinopathy: A systematic review with network meta‐analyses

Objective Diplopia Outcomes for Patients Treated With Teprotumumab for Thyroid Eye Disease

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