Mycophenolate plus methylprednisolone versus methylprednisolone alone in active, moderate-to-severe Graves' orbitopathy (MINGO): a randomised, observer-masked, multicentre trial

Kahaly, George J.; Riedl, Michaela; König, Jochem; Pitz, Susanne; Ponto, Katharina A.; Diana, Tanja; Kampmann, Elena; Kolbe, E.; Eckstein, Anja; Moeller, Lars C.; Führer, Dagmar; Salvi, Mario; Currò, Nicola; Campi, Irene; Covelli, Danila; Leo, Marenza; Marinò, Michele; Menconi, Francesca; Marcocci, Claudio; Bartalena, Luigi; Perros, Petros; Wiersinga, Wilmar M.

doi:10.1016/s2213-8587(18)30020-2

Cited by 145 publications

(151 citation statements)

References 26 publications

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“…It is of note that even among this group of possible ‘enthusiasts' second-line medical therapy after steroids was not used by 32% of respondents and in many areas was provided in a different trust. This is particularly relevant in view of recent evidence of the marginal benefits of adjunctive therapy combined with steroids [ 20 , 21 ]. Access to orbital decompression surgery seems available in most parts of the UK, though frequently in a different trust.…”

Section: Discussionmentioning

confidence: 99%

A survey of current practices by the British Oculoplastic Surgery Society (BOPSS) and recommendations for delivering a sustainable multidisciplinary approach to thyroid eye disease in the United Kingdom

Lee

Avari

Williams³

et al. 2019

Eye

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Background The Royal College of Physicians (RCP) and Thyroid Eye Disease Amsterdam Declaration Implementation Group (TEAMeD-5) have the common goal of improving access to high quality care for thyroid eye disease (TED). The TEAMeD-5 programme recommends all patients with moderate-to-severe TED should have access to multidisciplinary clinics (MDT) with combined Ophthalmology and Endocrinology expertise. Methods The British Oculoplastic Surgery Society represents oculoplastic surgeons who usually lead TED care in the UK. A two-stage survey of the membership was conducted to ascertain current practice of existing resources. Results Seventy percent (45/65) of respondents in Survey 1 were aware of current RCP guidance, but only 49% (22/45) rated it as a good means of improving access to comprehensive TED service. Sixty percent (39/65) of respondents are working in a multidisciplinary TED clinic with co-location of ophthalmologists and endocrinologists. Care for TED appears not to be provided in a multidisciplinary context in up to 31% (20/65). Thirty five (54%) of the respondents rated their relationship with endocrinology colleagues as good. Best practice guidelines recommend routine quality of life assessments but only 6/28 (21%) of respondents use this modality in current practice. Six percent (4/65) of areas appear not to be using intravenous steroids. In many areas (25%, 16/65), second-line immunosuppression is provided in a different trust and in 8% (5/65), it appears not to be used at all. Conclusion This survey is a 'snapshot' of current TED management in the UK and findings suggest scope for improvement. We recommend a framework for more robust collaboration across specialties and propose standards endorsed by multidisciplinary stakeholder societies.

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Section: Discussionmentioning

confidence: 99%

A survey of current practices by the British Oculoplastic Surgery Society (BOPSS) and recommendations for delivering a sustainable multidisciplinary approach to thyroid eye disease in the United Kingdom

Lee

Avari

Williams³

et al. 2019

Eye

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“…A second trial has then tested the possible additive effect between MMF and glucocorticoids. In this trial Kahaly et al [133] compared MMF plus IV GC versus IV GC alone and found that at 12 weeks the two treatments were not different in their overall rate of response, neither was the relapse rate at 24 and 36 weeks. However, on post-hoc analysis classifying patients into 3 ordered categories, a benefit was detected for the combinations therapy at both 24 and 36 weeks.…”

Section: Mycophenolate Mofetilmentioning

confidence: 98%

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.

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“…Patients affected with mild GO can be treated with lubricants and/or selenium (1,23,24), whereas, according to the European Group On Graves' Orbitopathy (EUGOGO) guidelines, high dose intravenous glucocorticoids GC (ivGC) are the first line treatment for moderately severe and active GO (1). However, more recently, new medications have been proposed, including rituximab (25), teprotumumab (26,27), mycophenolate (28), and tocilizumab (29). Finally, orbital decompression, squint or palpebral surgery can be considered in patients with an inactive disease, for therapeutic or rehabilitative purposes (30).…”

Section: Brief Notes On Gomentioning

confidence: 99%

Cholesterol Serum Levels and Use of Statins in Graves' Orbitopathy: A New Starting Point for the Therapy

et al. 2020

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Graves' Orbitopathy (GO) is the most frequent extrathyroidal manifestation of Graves' disease (GD). Its ultimate cause remains unclear, but it is commonly considered an autoimmune disorder due to self recognition of autoantigens constitutively expressed by orbital fibroblasts (OFs), and thyroid epithelial cells. High dose intravenous glucocorticoids (ivGC) are the most commonly used treatment for moderately severe and active GO. However, based on the complex pathogenesis of GO, a number of factors may have a protective and maybe a therapeutic role. The use of other medications improving the effect of GC may increase the overall effectiveness of the therapy and reduce GC doses, thereby limiting side effects. Recently, a possible protective role of 3-hydroxy-3-methylglutaryl-coenzyme reductase inhibitors, the so-called statins, and perhaps of lowering cholesterol levels, has been proposed. Thus, statins have been reported to be associated with a reduced frequency of GO in GD patients and in recent cross-sectional and retrospective studies a significant correlation was found between the occurrence of GO and both total and LDL-cholesterol in patients with a GD of relatively recent onset, suggesting a role of cholesterol in the development of GO. Moreover, a correlation was found between the GO clinical activity score and total as well as LDL-cholesterol in untreated GO patients, depending on GO duration, indicating a role of cholesterol on GO activity. Therefore, statin treatment may be beneficial for GO. Here we review this subject, which offers new therapeutic perspectives for patients with GO.

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Mycophenolate plus methylprednisolone versus methylprednisolone alone in active, moderate-to-severe Graves' orbitopathy (MINGO): a randomised, observer-masked, multicentre trial

Cited by 145 publications

References 26 publications

A survey of current practices by the British Oculoplastic Surgery Society (BOPSS) and recommendations for delivering a sustainable multidisciplinary approach to thyroid eye disease in the United Kingdom

A survey of current practices by the British Oculoplastic Surgery Society (BOPSS) and recommendations for delivering a sustainable multidisciplinary approach to thyroid eye disease in the United Kingdom

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

Cholesterol Serum Levels and Use of Statins in Graves' Orbitopathy: A New Starting Point for the Therapy

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