Comparative Efficacy of Four Treatments in Patients with Graves’ Disease: a Network Meta-analysis

Ren, Zhong; Lan, Qing; Wang, J. Q.; Li, Y.; Li, J.; Zhang, R.-G.

doi:10.1055/s-0035-1548824

Cited by 6 publications

(11 citation statements)

References 15 publications

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“…In the meta-analysis conducted by Acharya et al, 37 radioiodine therapy significantly increased the incidence of developing or worsening of ophthalmopathy compared with antithyroid drugs (RR 5 4.23, 95% CI: 2.04, 8.77). Similarly, the other network meta-analysis by Ren et al 38 suggests that treatment with antithyroid drugs significantly decreased the incidence of new or deteriorative ophthalmopathy compared with radioiodine therapy (OR 5 2.958, 95% CI: 1.731, 4.735).…”

Section: Discussionmentioning

confidence: 82%

“…37,38 Our meta-analysis expands on these two earlier meta-analyses to provide a better evidence for an effective comparison between the two treatments. First, there are an enlarged number of included studies and sample sizes in our analysis, which gives greater power to detect the outcome differences between the two treatments.…”

Section: Discussionmentioning

confidence: 97%

“…First, there are an enlarged number of included studies and sample sizes in our analysis, which gives greater power to detect the outcome differences between the two treatments. Whereas, in the network meta-analysis conducted by Ren et al, 38 only 4 RCTs (in a total of 1404 patients) were included, and the comparisons on ophthalmopathy were performed based on only 2 RCTs. Similarly, in another meta-analysis conducted by Acharya et al, 37 10 RCTs were included and only 2 RCTs compared the 2 treatments.…”

Section: Discussionmentioning

confidence: 99%

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Radioiodine therapy versus antithyroid drugs in Graves' disease: a meta-analysis of randomized controlled trials

Wang¹,

Lan²

2016

BJR

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Objective: This meta-analysis was performed to compare radioiodine therapy with antithyroid drugs in terms of clinical outcomes, including development or worsening of ophthalmopathy, hyperthyroid cure rate, hypothyroidism, relapse rate and adverse events. Methods: Randomized controlled trials (RCTs) published in PubMed, Embase, Web of Science, SinoMed and National Knowledge Infrastructure, China, were systematically reviewed to compare the effects of radioiodine therapy with antithyroid drugs in patients with Graves' disease. Results were expressed as risk ratio with 95% confidence intervals (CIs) and weighted mean differences with 95% CIs. Pooled estimates were performed using a fixed-effects model or random-effects model, depending on the heterogeneity among studies. Results: 17 RCTs involving 4024 patients met the inclusion criteria and were included. Results showed that radioiodine treatment has increased risk in new ophthalmopathy, development or worsening of ophthalmopathy and hypothyroidism. Whereas, compared with antithyroid drugs, radioiodine treatment seems to have a higher hyperthyroid cure rate, lower recurrence rate and lower incidence of adverse events. Conclusion: Radioiodine therapy is associated with a higher hyperthyroid cure rate and lower relapse rate compared with antithyroid drugs. However, it also increases the risk of ophthalmopathy and hypothyroidism.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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Radioiodine therapy versus antithyroid drugs in Graves' disease: a meta-analysis of randomized controlled trials

Wang¹,

Lan²

2016

BJR

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“…Among 26 included MAs, 16 [14,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] were published in English, including two Cochrane reviews [35,37], the other 10 [40][41][42][43][44][45][46][47][48][49] were published in Chinese. The median year of the publications was 2010.…”

Section: Characteristics Of Included Masmentioning

confidence: 99%

“…Eleven MAs reported relapse rates following, different interventions, as described below. Two [32,36] concluded that there were statistically significant differences in recurrence rates between total and subtotal thyroidectomy (TT and ST, respectively) with TT superior to ST. One MA [28] concluded that RAI therapy significantly reduced the recurrence rate compared to surgery. However, another MA [14] drew a different conclusion, that is, that the rate of recurrence did not differ significantly between RAI and surgery.…”

Section: Relapses Of Hyperthyroidismmentioning

confidence: 99%

Methodological Quality Assessment of Meta-Analyses of Hyperthyroidism Treatment

et al. 2017

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Hyperthyroidism is a common condition that is associated with increased morbidity and mortality. A number of meta-analyses (MAs) have assessed the therapeutic measures for hyperthyroidism, including antithyroid drugs, surgery, and radioiodine, however, the methodological quality has not been evaluated. This study evaluated the methodological quality and summarized the evidence obtained from MAs of hyperthyroidism treatments for radioiodine, antithyroid drugs, and surgery. We searched the PubMed, EMBASE, Cochrane Library, Web of Science, and Chinese Biomedical Literature Database databases. Two investigators independently assessed the meta-analyses titles and abstracts for inclusion. Methodological quality was assessed using the validated AMSTAR (Assessing the Methodological Quality of Systematic Reviews) tool. A total of 26 MAs fulfilled the inclusion criteria. Based on the AMSTAR scores, the average methodological quality was 8.31, with large variability ranging from 4 to 11. The methodological quality of English meta-analyses was better than that of Chinese meta-analyses. Cochrane reviews had better methodological quality than non-Cochrane reviews due to better study selection and data extraction, the inclusion of unpublished studies, and better reporting of study characteristics. The authors did not report conflicts of interest in 53.8% meta-analyses, and 19.2% did not report the harmful effects of treatment. Publication bias was not assessed in 38.5% of meta-analyses, and 19.2% did not report the follow-up time. Large-scale assessment of methodological quality of meta-analyses of hyperthyroidism treatment highlighted methodological strengths and weaknesses. Consideration of scientific quality when formulating conclusions should be made explicit. Future meta-analyses should improve on reporting conflict of interest.

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Treatment of patients with Graves' disease and the appropriate extent of thyroidectomy

Bobanga

McHenry

2019

Best Practice & Research Clinical Endocrinology & Metab

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Comparative Efficacy of Four Treatments in Patients with Graves’ Disease: a Network Meta-analysis

Abstract: Radioiodine+prednisone therapy might have the least probability of leading to an exacerbation or new appearance of ophthalmopathy, and radioiodine therapy might have the least probability of causing a recurrence.

Cited by 6 publications

References 15 publications

Radioiodine therapy versus antithyroid drugs in Graves' disease: a meta-analysis of randomized controlled trials

Radioiodine therapy versus antithyroid drugs in Graves' disease: a meta-analysis of randomized controlled trials

Methodological Quality Assessment of Meta-Analyses of Hyperthyroidism Treatment

Treatment of patients with Graves' disease and the appropriate extent of thyroidectomy

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