Gravesʼ Orbitopathy: Current Concepts for Medical Treatment

Abstract

Background The therapy of severe manifestations of Gravesʼ orbitopathy (GO) is still a challenge and requires good interdisciplinary cooperation. It is especially important to use stage-adapted anti-inflammatory therapy to avoid irreversible damage. Material and Methods Discussion of the latest results of multicentre randomised therapy studies on anti-inflammatory treatments for Gravesʼ orbitopathy, as well as new therapeutic concepts. Results Mild cases of GO can be treated with only selenium supplementation and a watchful waiting strategy. In the moderate-to-severe active form of GO, primary therapy consists of i. v. steroids (cumulative 4 – 5 g) in combination with orbital irradiation in patients with impaired motility. In patients with insufficient therapeutic response after 6 weeks, treatment should be switched to other immunosuppressive agents. In severe sight-threatening disease, bony orbital decompression is usually necessary. As basic research has improved our understanding of the underlying pathophysiology of GO, it has been possible to develop targeted therapies for GO. Teprotumumab, an IGF-1 receptor antibody, was effective in treating GO patients in a phase III trial and should soon be awarded approval for Europe. Conclusion The current therapy concept for Gravesʼ orbitopathy is as follows: first anti-inflammatory therapy then surgical correction of the permanent defects. This may soon be modified, due to the use of targeted therapies.

Interdisziplinäre Therapie der Erkrankungen der Orbita

“…Auch Ödeme, als Zeichen der Anwesenheit von Entzündungszellen und Entzündungsmediatoren, zeigen an, dass es zu einem schwereren Verlauf kommen kann 83 . Natürlich spielen auch Faktoren eine Rolle, die den Effekt der Hypoxie potenzieren, wie Rauchen 87 88 , Diabetes und höheres Patientenalter 81 . Hohe Cholesterinspiegel sind ebenfalls mit einer erhöhten Prävalenz einer EO assoziiert 89 .…”

Recent advances in graves ophthalmopathy medical therapy: a comprehensive literature review

“…Numerous studies have also proposed potential protein biomarkers for GO, allowing the early diagnosis and progress prediction of the GO [ 43 , 44 ]. After diagnosing, physicians should assess the clinical disease activity by Clinical Activity Score (CAS) [ 19 , 45 ] and severity by NOSPECS [ 46 , 47 ], VISA [ 19 , 48 ], and European Group on Graves Orbitopathy (EUGOGO) classification [ 49 , 50 ] (Table 1 ).…”

How Age Affects Graves’ Orbitopathy—A Tertiary Center Study

“…In severe cases, the disease can threaten sight mainly because of optic nerve compression [ 8 ]. Currently, in Europe available treatment options can often only reduce the inflammatory symptoms, but they cannot prevent rehabilitative surgery [ 9 , 10 , 11 ]. Therefore, it is of outmost importance to reduce risk factors for deterioration and initiate anti-inflammatory treatment early before irreversible tissue remodeling happens.…”