Common Immunosuppressive Monotherapy for Graves’ Ophthalmopathy: A Meta-Analysis

Abstract

BackgroundSeveral immunosuppressive therapeutic regimens are widely used to treat Graves’ ophthalmopathy (GO), including oral glucocorticoids (OGC), intravenous glucocorticoids (IVGC), retrobulbar injections of glucocorticoids (ROGC) and orbital radiotherapy (OR). The priority among these is unknown. This meta-analysis investigated the efficacy and tolerability of the above regimens.MethodsThe PubMed, EMBASE, and Cochrane Library databases and the Chinese Biomedicine Database were searched up to November 18, 2014. Randomized controlled trials (RCTs) comparing monotherapies (OGC, IVGC, ROGC and OR) in patients with moderate-to-severe active GO were selected. The main efficacy measures were the response rate, the standard mean difference (SMD) in the reduction in the clinical activity score (CAS) and the mean difference (MD) in proptosis from baseline to the end of treatment. The main tolerability measure was the risk ratio (RR) for adverse events. The pooled estimates and 95% confidence intervals (95% CIs) were calculated using the RevMan software, version 5.1.ResultsSeven published RCTs involving 328 participants were included in the present meta-analysis, including IVGC versus OGC (3 trials), ROGC versus OGC (3 trials) and OR versus OGC (1 trial). IVGC was more effective than OGC in response rate (RR = 1.48, 95% CI = 1.18–1.87) and had an obvious CAS reduction (SMD = 0.69, 95% CI = 0.13–1.25). IVGC caused fewer adverse events than OGC. ROGC and OGC had no statistically significant difference in response rate (RR = 1.16, 95% CI = 0.94–1.42). OR also did not differ significantly compared with OGC (RR = 0.93, 95% CI = 0.54–1.60). ROGC and OR had fewer adverse events, such as weight gain, compared with OGC.ConclusionsFor patients with GO in the moderate-to-severe active phase, current evidence gave priority to IVGC, which had a statistically significant advantage over OGC and caused fewer adverse events. ROGC and OR did not provide greater efficacy than OGC, although better tolerability and fewer adverse events were shown.

99Tc-MDP treatment for the therapy of rheumatoid arthritis, choroidal neovascularisation and Graves' ophthalmopathy

“…The exact etiology and underlying mechanism of GO remain to be elucidated. The natural history of GO varies from spontaneous remission to persistent or progressive disease (23,26), and glucocorticoid therapy is the primary treatment (23,(27)(28)(29).…”

Development of a core outcome set for amblyopia, strabismus and ocular motility disorders: a review to identify outcome measures

“…This was another common outcome measure; however there was incongruity in the position of gaze free from diplopia. Position of gaze was mostly not indicated [90, 93, 101, 105, 112, 115, 116, 127, 133, 141, 144, 146], however improvement was confined to primary gaze in a number of studies [106, 108, 114, 119].…”

“…Modified versions of existing scales are often developed and used (for example “modified EUGOGO” [101], and “modified Werner grading scale” for orbital inflammation [96]). In addition, we found a high frequency of a number of widely recognised scoring systems such as “The clinical activity score (CAS)” to assess disease activity [82, 84, 90, 92, 95, 97–99, 101, 103, 104, 108, 110–112, 114–116] and “NO SPECS” to assess disease severity. [82, 84, 90, 103, 104, 111] .…”

Comparative Efficacy of Medical Treatments for Thyroid Eye Disease: A Network Meta-Analysis

“…Recent published meta-analysis comparing common immunosuppressive therapies for TED concluded that IVGC is an effective treatment and has a significant advantage over OGC with fewer adverse events [6, 8]. Stiebel-Kalish et al found that a combination of glucocorticoids and OR was better than either treatment alone in a meta-analysis comparing all treatment modalities for TED [7].…”

“…Several traditional meta-analyses examining different treatment strategies for TED have been published [6–9], but each has some critical limitations. Since conventional meta-analysis can only compare two strategies, it is difficult to integrate all available data to generate a clear hierarchy among all treatment modalities.…”