Dose of intravenous steroids and therapy outcome in Graves’ orbitopathy
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Background and aim: Several trials have proved the efficacy of intravenous (IV) steroids in Graves’ orbitopathy (GO). However, the impact of administered dose and therapy schedule has not been assessed yet. Subjects and methods: Nine randomized and 14 non-randomized controlled trials of IV steroids in GO were evaluated according to the applied single and cumulative doses with respect to outcome, efficacy on clinically relevant issues and adverse events. Results: High single (1 g per day) and cumulative (>6 g) doses of IV steroids are superior to lower single (0.5 g/d) and cumulative (<5 g) doses with respect to therapy response (84 vs 75%; p=0.034 and 83 vs 77%; ns, respectively), improvement of eye symptoms (87 vs 75%, p=0.052 and 85 vs 71%; ns, respectively) and disappearance of diplopia (32 vs 27%; ns and 48 vs 27%; p=0.08, respectively). Decrease of both clinical activity score (3 vs 2.5 points and 2.5 vs 3, ns) as well as proptosis (−1.4 vs −1.2 mm, ns and 1.5 vs 1.2, ns) are similar in both groups. However, high single and/or cumulative doses are accompanied with a 2-fold higher rate of adverse events (56 vs 28%; p<0.001 and 52 vs 33%; p=0.034, respectively). Conclusions: Tailoring the IV steroid dose to severity of GO can be concluded and implies that a prospective randomized trial comparing different doses of IV steroids in active/severe GO is keenly warranted.
- Bartalena L, Tanda ML. Clinical practice. Graves’ ophthalmopathy. N Engl J Med 2009, 360: 994–1001. CrossRef
- Bahn RS. Graves’ ophthalmopathy. N Engl J Med 2010, 362: 726–38. CrossRef
- Bartalena L, Pinchera A, Marcocci C. Management of Graves’ ophthalmopathy: reality and perspectives. Endocr Rev. 2000, 21: 168–99.
- Bartalena L. The dilemma of how to manage Graves’ hyperthyroidism in patients with associated orbitopathy. J Clin Endocrinol Metab 2011, 96: 592–9. CrossRef
- Bartalena L. Editorial: glucocorticoids for Graves’ ophthalmopathy: how and when. J Clin Endocrinol Metab 2005, 90: 5497–9. CrossRef
- Bartalena L, Baldeschi L, Dickinson A, et al; European Group on Graves’ Orbitopathy (EUGOGO). Consensus statement of the European Group on Graves’ orbitopathy (EUGOGO) on management of GO. Eur J Endocrinol 2008, 158: 273–85. CrossRef
- Bartalena L, Baldeschi L, Dickinson AJ, et al. Consensus statement of the European group on Graves’ orbitopathy (EUGOGO) on management of Graves’ orbitopathy. Thyroid 2008, 18: 333–46. CrossRef
- Ponto KA, Hommel G, Pitz S, Elflein H, Pfeiffer N, Kahaly GJ. Quality of life in a German Graves’ Orbitopathy population. Am J Ophthalmol 2011, 152: 483–90. CrossRef
- Zang S, Ponto KA, Kahaly GJ. Intravenous glucocorticoids for Graves’ orbitopathy: efficacy and morbidity. J Clin Endocrinol Metab 2011, 96: 320–32. CrossRef
- Zang S, Kahaly GJ. Steroids and the immune response in Graves’ orbitopathy. Immunol Endocr Metab Agents Med Chem 2011, 11: 90–8. CrossRef
- Ponto KA, Zang S, Kahaly GJ. The tale of radioiodine and Graves’ orbitopathy. Thyroid 2010, 20: 785–93. CrossRef
- Macchia PE, Bagattini M, Lupoli G, Vitale M, Vitale G, Fenzi G. High-dose intravenous corticosteroid therapy for Graves’ ophthalmopathy. J Endocrinol Invest 2001, 24: 152–8. CrossRef
- Kauppinen-Mäkelin R, Karma A, Leinonen E, et al. High dose intravenous methylprednisolone pulse therapy versus oral prednisone for thyroidassociated ophthalmopathy. Acta Ophthalmol Scand 2002, 80: 316–21. CrossRef
- Kahaly GJ, Pitz S, Hommel G, Dittmar M. Randomized, single blind trial of intravenous versus oral glucocorticoid monotherapy in Graves’ orbitopathy. J Clin Endocrinol Metab 2005, 90: 5234–40. CrossRef
- Aktaran S, Akarsu E, Erbagci I, Araz M, Okumus S, Kartal M. Comparison of intravenous methylprednisolone therapy vs. oral methylprednisolone therapy in patients with Graves’ ophthalmopathy. Int J Clin Pract 2007, 61: 45–51. CrossRef
- Marcocci C, Bartalena L, Tanda ML, et al. Comparison of the effectiveness and tolerability of intravenous or oral glucocorticoids associated with orbital radiotherapy in the management of severe Graves’ ophthalmopathy: results of a prospective, single-blind, randomized study. J Clin Endocrinol Metab 2001, 86: 3562–7.
- Ng CM, Yuen HK, Choi KL, et al. Combined orbital irradiation and systemic glucocorticoids compared with systemic glucocorticoids alone in the management of moderate-to-severe Graves’ ophthalmopathy: a preliminary study. Hong Kong Med J 2005, 11: 322–30.
- Wakelkamp IM, Baldeschi L, Saeed P, Mourits MP, Prummel MF, Wiersinga WM. Surgical or medical decompression as a firstline treatment of optic neuropathy in Graves’ ophthalmopathy? A randomized controlled trial. Clin Endocrinol (Oxf) 2005, 63: 323–8. CrossRef
- Menconi F, Marinò M, Pinchera A, et al. Effects of total thyroid ablation versus near-total thyroidectomy alone on mild to moderate Graves’ orbitopathy treated with intravenous glucocorticoids. J Clin Endocrinol Metab 2007, 92: 1653–8. CrossRef
- van Geest RJ, Sasim IV, Koppeschaar HP, et al. Methylprednisolone pulse therapy for patients with moderately severe Graves’ orbitopathy: a prospective, randomized, placebo-controlled study. Eur J Endocrinol 2008, 158: 229–37. CrossRef
- Nagayama Y, Izumi M, Kiriyama T, et al. Treatment of Graves’ ophthalmopathy with high-dose intravenous methylprednisolone pulse therapy. Acta Endocrinol (Copenh) 1987, 116: 513–8.
- Kendall-Taylor P, Crombie AL, Stephenson AM, Hardwick M, Hall K. Intravenous methylprednisolone in the treatment of Graves’ ophthalmopathy. BMJ 1988, 297: 1574–8. CrossRef
- Hiromatsu Y, Tanaka K, Sato M, et al. Intravenous methylprednisolone pulse therapy for Graves’ ophthalmopathy. Endocr J 1993, 40: 63–72. CrossRef
- Tagami T, Tanaka K, Sugawa H, et al. High-dose intravenous glucocorticoid pulse therapy in thyroid-associated ophthalmopathy. Endocr J 1996, 43: 689–99. CrossRef
- Matejka G, Vergès B, Vaillant G, et al. Intravenous methylprednisolone pulse therapy in the treatment of Graves’ ophthalmopathy. Horm Metab Res 1998, 30: 93–8. CrossRef
- Ohtsuka K, Sato A, Kawaguchi S, Hashimoto M, Suzuki Y. Effect of high-dose intravenous steroid pulse therapy followed by 3-month oral steroid therapy for Graves’ ophthalmopathy. Jpn J Ophthalmol 2002, 46: 563–7. CrossRef
- Kulig G, Andrysiak-Mamos E, Sowiñska-Przepiera E, et al. Quality of life assessment in patients with Graves’ disease and progressive infiltrative ophthalmopathy during combined treatment with methylprednisolone and orbital radiotherapy. Endokrynol Pol 2009, 60: 158–65.
- Hart RH, Kendall-Taylor P, Crombie A, Perros P. Early response to intravenous glucocorticoids for severe thyroid-associated ophthalmopathy predicts treatment outcome. J Ocul Pharmacol Ther 2005, 21: 328–36. CrossRef
- Mensah A, Vignal-Clermont C, Chadi M, et al. Dysthyroid optic neuropathy: atypical initial presentation and persistent visual loss. Orbit 2009, 28: 354–62. CrossRef
- Koshiyama H, Koh T, Fujiwara K, Hayakawa K, Shimbo S, Misaki T. Therapy of Graves’ ophthalmopathy with intravenous highdose glucocorticoid followed by orbital irradiation. Thyroid 1994, 4: 409–13. CrossRef
- Sterker I, Tegetmeyer H, Papsdorf K, Führer-Sakel D. Effect of combined intravenous glucocorticoids and orbital radiotherapy in restoring driving competency in patients with Graves’ orbitopathy. Horm Metab Res 2009, 41: 391–6. CrossRef
- Ohtsuka K, Sato A, Kawaguchi S, Hashimoto M, Suzuki Y. Effect of steroid pulse therapy with and without orbital radiotherapy on Graves’ ophthalmopathy. Am J Ophthalmol 2003, 135: 285–90. CrossRef
- Salvi M, Vannucchi G, Campi I, et al. Treatment of Graves’ disease and associated ophthalmopathy with the anti-CD20 monoclonal antibody rituximab: an open study. Eur J Endocrinol 2007, 156: 33–40. CrossRef
- Sánchez-Ortiga R, Moreno-Pérez O, González Sánchez V, et al. Treatment of Graves’ ophthalmopathy with highdose intravenous methylprednisolone: a comparison of two dosing regimens. Endocrinol Nutr 2009, 56: 118–22. CrossRef
- Marcocci C, Watt T, Altea MA, et al. Fatal and non-fatal adverse events of glucocorticoid therapy for Graves’ orbitopathy: a questionnaire survey among members of the Europaen Thyroid Association. Eur J Endocrinol 2011, Nov 4 [E-pub ahead of print]; doi: 10.1530/EJE-11-0779.
- Dose of intravenous steroids and therapy outcome in Graves’ orbitopathy
Journal of Endocrinological Investigation
Volume 34, Issue 11 , pp 876-880
- Cover Date
- Print ISSN
- Online ISSN
- Springer International Publishing
- Additional Links
- Cumulative and single dose
- Graves’ orbitopathy
- intravenous steroids
- side effects
- Industry Sectors