Treatment of Graves' ophthalmopathy with high-dose intravenous methylprednisolone pulse therapy

Abstract

This preliminary study was undertaken to investigate the efficacy of high-dose iv methylprednisolone pulse therapy in 5 patients with Graves' ophthalmopathy. One gram of methylprednisolone sodium succinate was given iv daily for 3 successive days. The 3-day infusion was repeated 3 to 7 times at intervals of 1 week; total duration of pulse therapy was 3 to 7 weeks. The clinical improvement of eye involvements by pulse therapy was assessed immediately after the last pulse therapy. The clinical assessment of the effect of pulse therapy for Graves' ophthalmopathy showed a good response in 3 patients, a fair response in one, and no response in one. However, in one patient, who was judged to show no response, complete improvement of the enlarged extraocular muscle was observed on orbital computed tomography. Moreover, two patients, who have been followed without any other therapies, showed no relapse of eye involvements for 32 and 10 months, respectively. Although it is impossible to determine whether pulse therapy is more effective than other immunosuppressive therapies, the results of this preliminary study suggest that pulse therapy may be a good immunosuppressive therapy for Graves' ophthalmopathy too. Controlled studies are desired.

Effect of High Dose Methylprednisolone Pulse Therapy Followed by Oral Prednisolone Administration on the Production of Anti-TSH Receptor Antibodies and Clinical Outcome in Graves' Disease

“…Exceptionally large amounts of glucocorticoids are used for Graves' patients with severe ophthalmopathy. In these cases, the high dose of intravenous methylprednisolone pulse therapy (pulse therapy) often improves ophthalmic symptoms [4][5][6][7][8][9][10][11][12][13][14][15].…”

Treatment of Graves' ophthalmopathy

“…Глюкокортикоиды в лечении инфильтративной офтальмопатии используются с 60 х годов ХХ века и на сегодняшний день остаются наиболее эффектив ным и доступным методом [7,9,10,26,35]. ГК спо собствуют снижению сосудистой проницаемости, стабилизации лизосомальных мембран, уменьше нию вазодилатации, экссудации, накопления в тка нях лейкоцитов, как нейтрофилов, так и моноцитов, нарушению дифференцировке моноцитов в макро фаги, а также подавляют синтез и секрецию гликоза миногликанов фибробластами орбиты.…”

“…Первые исследования пульс терапии метилпреднизолоном были опубли кованы в 1987 г. Y. Nagayama и соавт. [35]. В дальней шем результаты исследований эффективности и бе зопасности такой терапии опубликовали P. Kendall Taylor (1988), P. Dandona (1989), J.…”

“…Кумулятивная доза стероидов в различных исследо ваниях варьировала от 1 до 21 г [13,14,16,23]. Так же как и при пероральном приеме, положительная динамика наблюдалась со стороны мягких тканей орбит, регрессии оптической нейропатии, тогда как эффект на проптоз и функцию экстраокулярных мышц был менее выраженным [13,14,16,23,35]. Что касается побочных эффектов, то, по данным C. Marcocci, L. Bartalena (2001), G.J.…”

High-Dose Intravenous Steroid Pulse Therapy in Thyroid-Associated Ophthalmopathy.

“…Although high-dose systemic corticosteroids, e. g. prednisolone 80-100 mg daily, have been used with some success, there is a high tendency to relapse as the steroid doses are reduced and often maintenance levels of 30 mg per day or more are needed, which leads an increase in the frequency and severity of adverse effects [16]. Intravenous methylprednisolone, which should be used only with strict medical monitoring and hospitalization, is more effective and its adverse effects are less [17][18][19][20]. Radiotherapy has re-emerged as another useful form of treatment, e. g. megavoltage,…”