Treatment of Graves’ ophthalmopathy with high-dose intravenous methylprednisolone: a comparison of two dosing regimens

Sánchez-Ortiga, Ruth; Moreno-Pérez, Óscar; Sánchez, Víctor González; Mendoza, Nieves Arias; Dot, Montserrat Mauri; Guerra, Rocío Alfayate; Maciá, Alicia López; Alfonso, Antonio Picó

doi:10.1016/s1575-0922(09)70841-1

Cited by 13 publications

(13 citation statements)

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“…Relapse rate observed in the present study was 9.5%, which is lower compared to 21% and 43% of recurrences observed in previous studies 6,26. Bartalena et al conclude that recurrence of GO after the initial improvement, even for patients who received large doses of GCs (7.5 g of MP in 12 weeks), is probably caused by the abrupt steroid withdrawal, and proposes oral GC tapering, although the evidence for this until now was lacking 6.…”

Section: Discussioncontrasting

confidence: 80%

“…The latter show an overall response rate of 35%–80% and CAS improvement of 64.1%–83% 6,13,14,25,26. Nevertheless, with the addition of oral GC treatment in the present study, for patients with persistent active disease, the overall response rate and the CAS improvement increased remarkably, reaching 92.8% and 97.6% of patients, respectively.…”

Section: Discussioncontrasting

confidence: 44%

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Clinical and imaging evaluation of the response to intravenous steroids in patients with Graves’ orbitopathy and analysis on who requires additional therapy

Tsirouki¹,

Bargiota²,

Tigas³

et al. 2016

OPTH

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ObjectiveThe aim of this study was to evaluate the safety and efficacy of an individualized steroid regimen in patients with moderate-to-severe Graves’ orbitopathy (GO) by monitoring clinical and imaging parameters.MethodsIn total, 47 patients with active, moderate-to-severe GO were enrolled in this study. All the patients received the proposed treatment regimen by European Group on GO of 4.5 g of intravenous (IV) methylprednisolone for 12 weeks. At the end of the IV treatment, patients with persistent active GO (Group 1) who were assessed by clinical examination and orbital imaging with short tau inversion recovery-sequence magnetic resonance imaging (STIR MRI) received additional treatment with oral prednisolone, and those with inactive GO (Group 2) received no further treatment.ResultsOf the 42 patients who completed the study, 22 (52.4%) patients formed Group 1 and 20 (47.6%) patients Group 2. At the 12th week, the overall response to IV treatment was 76.2%, and clinical activity score (CAS) improvement was 69%. At the 24th week, the overall response was 92.8%, and CAS improvement was 97.6%, without statistically significant difference in CAS and total eye score between these two groups (P=0.157 and P=0.856, respectively). Ophthalmic manifestations were improved, being absent or minimal in 78.6% of patients at the 24th week follow-up. Recurrence of disease activity occurred in 9.5% of patients up to 24 weeks after the completion of treatment, and major adverse events occurred in 6.4% of patients.ConclusionIn patients with moderate-to-severe GO, IV steroid treatment, followed by oral treatment, when needed, is an effective regimen with low rates of adverse events and recurrences. STIR MRI is a significant tool for recognizing patients who need additional steroid treatment.

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Section: Discussioncontrasting

confidence: 80%

Section: Discussioncontrasting

confidence: 44%

Clinical and imaging evaluation of the response to intravenous steroids in patients with Graves’ orbitopathy and analysis on who requires additional therapy

Tsirouki¹,

Bargiota²,

Tigas³

et al. 2016

OPTH

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“…Clinical trials [6,7] have showed that with the same administration method, a better response was proportional to receiving larger doses of iv MP in the range of safe dosage. Our study shown similar results again (Table 2).…”

Section: Discussionmentioning

confidence: 99%

“…The commonly recommended treatment is a course of 0.5 g of iv MP once a week for 6 weeks, followed by 0.25 g weekly for 6 weeks (cumulative dose of 4.5 g) [1]. Recently, comparative studies of different cumulative doses and administration methods of iv MP have been performed [6][7][8].…”

mentioning

confidence: 99%

Comparison of two different regimens of intravenous methylprednisolone for patients with moderate to severe and active Graves’ ophthalmopathy: a prospective, randomized controlled trial

et al. 2017

Endocr J

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“…In a number of case reports, the risks of liver failure have been reported during IVMP resulting in fatal expiration in four patients so far [ 32 -34 ]. These patients received a cumulative dosage of 10-24 g. Sanchez-Ortiga et al [ 35 ] compared two dosing regimes of i.v. steroids and found the lower dose to be much better tolerated.…”

Section: Intravenously Administered Glucocorticosteroidsmentioning

confidence: 99%

Medical Treatment of Moderately Severe and Vision-Threatening Graves’ Orbitopathy

Mourits

2015

Graves' Disease

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Treatment of Graves’ ophthalmopathy with high-dose intravenous methylprednisolone: a comparison of two dosing regimens

Cited by 13 publications

References 10 publications

Clinical and imaging evaluation of the response to intravenous steroids in patients with Graves’ orbitopathy and analysis on who requires additional therapy

Clinical and imaging evaluation of the response to intravenous steroids in patients with Graves’ orbitopathy and analysis on who requires additional therapy

Comparison of two different regimens of intravenous methylprednisolone for patients with moderate to severe and active Graves’ ophthalmopathy: a prospective, randomized controlled trial

Medical Treatment of Moderately Severe and Vision-Threatening Graves’ Orbitopathy

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Treatment of Graves’ ophthalmopathy with high-dose intravenous methylprednisolone: a comparison of two dosing regimens

Cited by 13 publications

References 10 publications

Clinical and imaging evaluation of the response to intravenous steroids in patients with Graves&rsquo; orbitopathy and analysis on who requires additional therapy

Clinical and imaging evaluation of the response to intravenous steroids in patients with Graves&rsquo; orbitopathy and analysis on who requires additional therapy

Comparison of two different regimens of intravenous methylprednisolone for patients with moderate to severe and active Graves&rsquo; ophthalmopathy: a prospective, randomized controlled trial

Medical Treatment of Moderately Severe and Vision-Threatening Graves’ Orbitopathy

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Clinical and imaging evaluation of the response to intravenous steroids in patients with Graves’ orbitopathy and analysis on who requires additional therapy

Clinical and imaging evaluation of the response to intravenous steroids in patients with Graves’ orbitopathy and analysis on who requires additional therapy

Comparison of two different regimens of intravenous methylprednisolone for patients with moderate to severe and active Graves’ ophthalmopathy: a prospective, randomized controlled trial