Antithyroid drugs and Graves' disease — prospective randomized assessment of long‐term treatment

Maugendre, D; Gatel, A; Campion, Loı̈c; Massart, Catherine; Guilhem, Isabelle; Lorcy, Y.; Lescouarch, J.; Herry, J. Y.; Allannic, H

doi:10.1046/j.1365-2265.1999.00629.x

Cited by 108 publications

(55 citation statements)

References 40 publications

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“…This is stronger with use of the Titration regimen (4, 5) than for the Block-Replace regimen (6), although the latter study was a quasi-randomised study. Two of the studies (7,8) using longer durations of therapy did not show any clear evidence of benefit in extending therapy beyond 18 months, although the CIs were wide.…”

Section: Discussionmentioning

confidence: 97%

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A systematic review of drug therapy for Graves’ hyperthyroidism

Abraham

Avenell

Park³

et al. 2005

eur j endocrinol

178

113

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We assessed the effects of dose, regimen and duration of anti-thyroid drug therapy for Graves' thyrotoxicosis on recurrence of hyperthyroidism, course of ophthalmopathy, adverse effects, health-related quality of life and economic outcomes. We undertook a systematic review and meta-analyses of randomised controlled trials (RCTs). We identified RCTs regardless of language or publication status by searching six databases, and trial registries. Dual, blinded data abstraction and quality assessment were undertaken. Trials included provided therapy for at least 6 months with follow-up at least 1 year after drug cessation. Fixed or random effects meta-analyses were used to combine study data. Twelve trials compared a Block-Replace regimen (requiring a higher dose of anti-thyroid drug treatment) with a Titration regimen. Overall, there was no significant difference between the regimens for relapse of hyperthyroidism (relative risk (RR) ¼ 0.93, 95% confidence interval (CI) 0.84 to 1.03). Participants were more likely to withdraw due to adverse events with a Block-Replace regimen (RR ¼ 1.89, 95% CI 1.25 to 2.85). Prescribing replacement thyroxine, either with the anti-thyroid drug treatment, or after this was completed, had no significant effect on relapse. Limited evidence suggested 12-18 months of anti-thyroid drug treatment should be used. The titration regimen appeared as effective as the Block-Replace regimen, and was associated with fewer adverse effects. However, relapse rates over 50% and high participant drop-out rates in trials mean that the results should be interpreted with caution, and may suggest that other strategies for the management of Graves' disease, such as radioiodine, should be considered more frequently as first-line therapy. There were no data on the course of ophthalmopathy, health-related quality of life and economic outcomes.European Journal of Endocrinology 153 489-498

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Section: Discussionmentioning

confidence: 97%

“…Two other studies used longer durations of Titration regimen, comparing 12 months with 24 months (7) and 18 months with 42 months of therapy (8). Combining these showed no significant difference between the longer and shorter durations of treatment (RR ¼ 0.88, 95% CI 0.67 to 1.16).…”

mentioning

confidence: 99%

A systematic review of drug therapy for Graves’ hyperthyroidism

Abraham

Avenell

Park³

et al. 2005

eur j endocrinol

178

113

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“…If thionamides are used to treat Graves' disease they can usually be discontinued after a course of treatment, ranging from 6-18 months, with approximately 50% of patients remaining in remission thereafter (Hedley et al 1989, Maugendre et al 1999. In most centres, titration regime is administered for 18 months, whereas block and replace is usually given for 6 months only .…”

Section: Medicalmentioning

confidence: 99%

Treatment Modalities in Thyroid Dysfunction

King¹,

Ajjan²

2012

Thyroid and Parathyroid Diseases - New Insights Into Some Old and Some New Issues

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“…A forma ideal de tratamento é difícil de ser estabelecida devido ao curso natural da doença ser longo, variável de um paciente para outro e também pela falta de marcadores precisos preditivos de remissão (6)(7)(8).…”

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“…Os antitiroidianos restituem o eutiroidismo de forma eficiente na fase inicial da terapêutica (2,7,10,12,13). O tratamento é geralmente iniciado com doses elevadas dos agentes antitiroidianos que são progressivamente diminuídas conforme a melhora clíni-ca e laboratorial do paciente (2,12,13).…”

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Avaliação do intervalo de tempo e custo médio para a obtenção do eutiroidismo na doença de graves tratada com drogas antitiroidianas em um hospital geral

Nirschl

Kater

Nascif

et al. 2001

Arq Bras Endocrinol Metab

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Most of the Graves' disease patients become euthyroid between 6 and 12 weeks after antithyroid drug use. Patients' compliance to the medication is essential for a successful therapy. The aims of the present study were to evaluate retrospectively the time spent to obtain clinical and hormonal euthyroidism, the costs of the clinical therapy in outpatients with Graves' disease and to compare them with the literature data. Eighty-two patients were selected between February/96 and November/97 and were followed-up until July/99. Forty-nine (59.8%) returned regularly until reaching euthyroidism, which occurred at a mean time of 24.8 weeks. Only 11 patients were euthyroid in 12 weeks. Sixteen patients were considered no compliant and the time necessary to reach the euthyroidism was significantly higher than that of the compliant group (37.3 vs. 18.7 weeks). The rate of the patients who abandoned follow-up before reaching the euthyroidism was 36,6%. The mean cost for 24.8 weeks treatment was R$248.72 versus R$151.68 for 12 weeks treatment, which is the period described in literature. In conclusion, our patients need more time to reach the euthyroidism than that usually described, which implies in 64% greater treatment cost. Poor compliance problems are the most important reason for this.

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Antithyroid drugs and Graves' disease — prospective randomized assessment of long‐term treatment

Cited by 108 publications

References 40 publications

A systematic review of drug therapy for Graves’ hyperthyroidism

A systematic review of drug therapy for Graves’ hyperthyroidism

Treatment Modalities in Thyroid Dysfunction

Avaliação do intervalo de tempo e custo médio para a obtenção do eutiroidismo na doença de graves tratada com drogas antitiroidianas em um hospital geral

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