Does early response to intravenous glucocorticoids predict the final outcome in patients with moderate-to-severe and active Graves’ orbitopathy?

Bartalena, Luigi; Veronesi, Giovanni; Krassas, Gerasimos E; Wiersinga, Wilmar M.; Marcocci, Claudio; Marinò, Michele; Salvi, Mario; Daumerie, Chantal; Bournaud, Claire; Stahl, Matthias; Sassi, Lorenza; Azzolini, Claudio; Boboridis, Kostas; Mourits, Maarten P.; Soeters, Maarten R.; Baldeschi, Lelio; Nardi, Marco; Currò, Nicola; Boschi, Antonella; Bernard, Martine; Arx, George von; Perros, Petros; Kahaly, George J.

doi:10.1007/s40618-017-0608-z

Cited by 64 publications

(49 citation statements)

References 20 publications

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“…Overall, AITD (45)(46) represent the most frequent autoimmune endocrinopathies within the scope of PAS and are present in 70-75% of the patients [15]. AITD within PAS can occur with or without Graves' orbitopathy [45][46][47].The second most prevalent endocrine autoimmune disease in the adult PAS type is T1D with 50-60% [48]. Combination of both diseases defines PAS type III, whereas AD, essential for PAS II, occurs in 40-50% of all cases with PAS.…”

Section: Adult Pasmentioning

confidence: 99%

Polyglandular autoimmune syndromes

Kahaly

Frommer

2017

J Endocrinol Invest

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130

101

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Section: Adult Pasmentioning

confidence: 99%

Polyglandular autoimmune syndromes

Kahaly

Frommer

2017

J Endocrinol Invest

Self Cite

130

101

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“…Using CAS, a very useful, although imperfect, tool for assessing inflammation, inactivation of TAO (final CAS ≤2/7) has been reported in about 60% of cases in 9 randomized studies and 90% of cases in 13 non-randomized studies (103). Inactivation may occur very early (within a few weeks, but even slightly later during the intravenous glucocorticoid treatment) (113). In a large randomized clinical trial of 159 patients, CAS decreased by at least two points in more than 80% of patients receiving a cumulative dose of intravenous methylprednisolone of 5 or 7.5 g and about 60% in those given a cumulative dose of 2.5 g (112).…”

Section: The Road Beyond Initial Investigation Of Biologicals -Restormentioning

confidence: 99%

Will biological agents supplant systemic glucocorticoids as the first-line treatment for thyroid-associated ophthalmopathy?

Smith

Bartalena

2019

European Journal of Endocrinology

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In this article, the two authors present their opposing points of view concerning the likelihood that glucocorticoids will be replaced by newly developed biological agents in the treatment of active, moderate-to-severe thyroid-associated ophthalmopathy (TAO). TAO is a vexing, disfiguring and potentially blinding autoimmune manifestation of thyroid autoimmunity. One author expresses the opinion that steroids are nonspecific, frequently fail to improve the disease and can cause sometimes serious side effects. He suggests that glucocorticoids should be replaced as soon as possible by more specific and safer drugs, once they become available. The most promising of these are biological agents. The other author argues that glucocorticoids are proven effective and are unlikely to be replaced by biologicals. He reasons that while they may not uniformly result in optimal benefit, they have been proven effective in many reports. He remains open minded about alternative therapies such as biologicals but remains skeptical that they will replace steroids as the first-line therapy for active, moderate-to-severe TAO without head-to-head comparative clinical trials demonstrating superiority. Despite these very different points of view, both authors are optimistic about the availability of improved medical therapies for TAO, either as single agents or in combination. Further, both agree that better treatment options are needed to improve the care of our patients with active moderate-to-severe TAO.

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“…The currently used total dose is 4.5 g of methylprednisolone, with the higher dosage of 7.5 g being slightly more effective albeit with greater toxicity [94]. Bartalena et al showed that those who deteriorate at 6 weeks after IV GCs are unlikely to benefit from continuing IV GCs as 63 % and 53 % remained in the same GO category at 12 and 24 weeks respectively [95]. In the same study, the patients who were unresponsive at 6 weeks eventually improved in 28 % of cases for composite GO index, 58 % for CAS and 32 % for quality of life, suggesting that this group still has a significant possibility of improvement later [95].…”

Section: Glucocorticoidsmentioning

confidence: 99%

Current and Future Treatments for Graves’ Disease and Graves’ Ophthalmopathy

Kotwal

Stan

2018

Horm Metab Res

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The course and pathogenesis of Graves’ disease and Graves’ ophthalmopathy are interdependent, influencing each other’s therapeutic choices. Multiple factors including geographic location, access to medical services, patient and physician preferences influence the management of these conditions. Graves’ disease is classically managed with one of three treatment options – antithyroid drugs, radioactive iodine, and thyroidectomy. In recent years, there has been a shift towards antithyroid drugs, including long term therapy with these agents, given the advantage of avoiding hypothyroidism and the apparent safety of this approach. In addition, new therapies are (slowly) emerging, focusing on immunomodulation. Technological advances are opening doors to non-pharmaceutical interventions that aim to deal with both structural thyroid abnormalities as well as biochemical abnormalities of hyperthyroidism. Graves’ ophthalmopathy management is guided by its activity and severity status, with treatment options including smoking cessation, control of hyperthyroidism, local eye measures, glucocorticoids, selenium, orbital radiotherapy, and surgery. In addition to these established treatment choices, new immunotherapy-based approaches are being tested. Some of them (tocilizumab and teprotumumab) are very promising but further evaluation is needed before we can establish their role in clinical care. Agents identified as beneficial in Graves’ disease management will likely be tested in Graves’ ophthalmopathy as well. In the coming years, our main clinical responsibility will be to find the proper balance between the benefits and potential risks of these incoming therapies, and to identify the subgroups of patients where this ratio is most likely to favor a safe and successful therapeutic outcome.

show abstract

Does early response to intravenous glucocorticoids predict the final outcome in patients with moderate-to-severe and active Graves’ orbitopathy?

Cited by 64 publications

References 20 publications

Polyglandular autoimmune syndromes

Polyglandular autoimmune syndromes

Will biological agents supplant systemic glucocorticoids as the first-line treatment for thyroid-associated ophthalmopathy?

Current and Future Treatments for Graves’ Disease and Graves’ Ophthalmopathy

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