Methylprednisolone and Graves' ophthalmopathy.

Dandona, Paresh; Havard, C. W. H.; Mier, Andrés

doi:10.1136/bmj.298.6676.830

Cited by 12 publications

(5 citation statements)

References 6 publications

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“…Reported side effects of PPT are rare. In small numbers of patients, body weight gain, induction of diabetes mellitus, elevation of blood pressure, pyloric ulcer, increased osteoporosis and increase in insulin dosage were noted (15,16). Cases of sometimes fatal autoimmune hepatitis following i.v.…”

Section: Introductionmentioning

confidence: 99%

Methylprednisolone pulse therapy for patients with moderately severe Graves' orbitopathy: a prospective, randomized, placebo-controlled study

Geest¹,

Sasim²,

Koppeschaar³

et al. 2008

European Journal of Endocrinology

110

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Objective: To assess whether methylprednisolone (MP) pulse therapy is efficacious in the treatment of moderately severe Graves' orbitopathy (GO). Design: Prospective, placebo (PL)-controlled, double-blind, randomized study. Methods: Fifteen previously untreated patients with active, moderately severe GO participated in the study; 6 patients received MP and 9 patients a PL. Moderately severe disease was defined using the NOSPECS classification of clinical signs of GO . Activity was measured with the clinical activity score (CAS). A dose of 500 mg MP or only solvent was administered intravenously, over three consecutive days, in four cycles at 4 weekly intervals (6 g of MP in total). Qualitatively, a successful treatment outcome was defined as an improvement in one major and/or two minor criteria in the worst eye at week 48. The major criteria were: improvement in diplopia grade; improvement in eye movement; a decrease in CAS of three points. The minor criteria were: decrease of eyelid retraction; decrease of proptosis; improvement in grade of soft tissue swelling; a decrease in CAS of two points. Results: The qualitative treatment outcome was successful at the end of the trial in five out of six (83%) patients receiving MP and in one out of nine (11%) patients given the PL (relative riskZ7.5; (95% confidence interval 1.1-49.3), PZ0.005). The treatment was well tolerated. Conclusions: In spite of the small number of patients, a significant difference in outcome was observed between MP-and PL-treated patients. We conclude that MP pulse therapy appears to be an effective treatment for active, moderately severe GO.European Journal of Endocrinology 158 229-237

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Section: Introductionmentioning

confidence: 99%

Methylprednisolone pulse therapy for patients with moderately severe Graves' orbitopathy: a prospective, randomized, placebo-controlled study

Geest¹,

Sasim²,

Koppeschaar³

et al. 2008

European Journal of Endocrinology

110

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“…The total corticosteroid dose used in our study averaged 3.5 g (2.25 -4.5 g) versus Ito 21 gin the previous reports. None of our patients required immunosuppressive or radiation treatments after MP therapy, while many patients required such treatment in the previous studies (33,34,35). Our MP pulse therapy has less constraints than those previously reported.…”

Section: Discussionmentioning

confidence: 60%

Intravenous Methylprednisolone Pulse Therapy in the Treatment of Graves' Ophthalmopathy

Matejka¹,

Vergès²,

Vaillant³

et al. 1998

Horm Metab Res

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Graves' ophthalmopathy (GO) is a specific immune-mediated disorder, whose treatment is sometimes difficult. In order to investigate the efficacy of intravenous methylprednisolone (MP) pulse therapy in GO, we studied eight patients with GO, followed up for at least 6 months by clinical patient self-assessment, ophthalmological examination and orbital computed tomography (OCT). A 12.5 mg/kg dose of MP was administered intravenously over a 10 hour period, once every month. Three to six MP pulse administrations were performed in each patient. All patients were outpatients. A 0.5 mg/kg/day oral prednisone dose was given to each patient as interpulse therapy. Clinical assessment of MP pulse therapy showed a good response in 87.5% and no response in 12.5% of patients. The treatment was rapidly efficient, mostly on patient self-assessment, soft tissue inflammation, ophthalmoplegia, corneal involvement, visual acuity and extraocular muscle enlargement on OCT. Post-treatment ophthalmic index was significantly improved (6.75 +/- 3.06 vs. 2.5 +/- 1.41: p < 0.05). MP pulse therapy had less effect on proptosis (22.94 +/- 2.32 mm vs. 21.56 +/- 2.22 mm: p < 0.05). No adverse effects were noted with MP pulse therapy. Patients showed no relapse of eye involvement during a mean follow up of 31.8 months (2-77 months). In conclusion, our results suggest that intravenous MP pulse therapy is a good immunosuppressive therapy for GO. Moreover, in comparison with the previous studies, the MP dose used in our present study appears to be optimal with high efficacy. MP pulse therapy represents a safe and efficient treatment in GO, which can easily be performed in outpatients.

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“…Intravenous GC (IVGC) pulse therapy (methylprednisolone) was introduced in the late 1980s to exploit the immunosuppressive effect of GC while reducing their side effects ( 25 ). Early protocols have varied widely, with early studies using up to 3 g of methylprednisolone weekly ( 25 , 26 ) plus or minus oral prednisone between pulses ( 27 ). In these uncontrolled studies, the response rate has been estimated at 75% to 80%, therefore higher than with OGC alone ( 24 , 28 ).…”

Section: Systemic Medical Therapymentioning

confidence: 99%

Future Projections in Thyroid Eye Disease

Barbesino

Salvi

Freitag

2022

The Journal of Clinical Endocrinology &Amp; Metabolism

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Background and Aims This review aims to summarize current and emerging therapies for treatment of thyroid eye disease (TED), in the light of novel understanding of pathogenetic mechanisms, leading to new treatment options and clinical trials. Methods We reviewed and analyzed peer-reviewed literature reporting recent translational studies and clinical trials in the treatment of TED. Searches were made at www.pubmed.gov with keywords “thyroid eye disease,” “Graves’ ophthalmopathy,” “thyroid orbitopathy,” and “Graves’ orbitopathy.” Results Surgery is reserved for rehabilitation in chronic TED or for emergent compressive optic neuropathy. Oral and intravenous glucocorticoid therapy has been used for decades with variable efficacy in acute TED, but results may be temporary and side effects significant. Nonsteroidal oral immunosuppressive agents offer modest benefit in TED. Several immunomodulatory monoclonal antibodies, including rituximab and tocilizumab, have shown efficacy for inactivating TED. Recently, teprotumumab, an insulin-like growth factor 1 receptor (IGF-1R) inhibitor, has demonstrated significant improvement in proptosis, clinical activity score, diplopia, and quality of life in patients with active TED, with good tolerability. Newly proposed TED therapies, currently in preclinical and clinical trial phases, include thyroid-stimulating hormone (TSH) receptor inhibitory drugs, RVT-1401, local anti-vascular endothelial growth factor therapy, IGF-1R drugs delivered subcutaneously and orally, and desensitization to the TSH receptor with modified TSH receptor peptides. Conclusion New, albeit incomplete, understanding of the molecular mechanisms of TED has led to new promising therapies and offered improved outcomes in TED patients. Their full role and their relationship to classical immune suppression should be clarified over the next few years.

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Methylprednisolone and Graves' ophthalmopathy.

Cited by 12 publications

References 6 publications

Methylprednisolone pulse therapy for patients with moderately severe Graves' orbitopathy: a prospective, randomized, placebo-controlled study

Methylprednisolone pulse therapy for patients with moderately severe Graves' orbitopathy: a prospective, randomized, placebo-controlled study

Intravenous Methylprednisolone Pulse Therapy in the Treatment of Graves' Ophthalmopathy

Future Projections in Thyroid Eye Disease

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