Intravenous Glucocorticoid Treatment for Korean Graves' Ophthalmopathy Patients.

Abstract

BACKGROUND:

High-dose intravenous steroids are the first-line treatment for patients with moderate-to-severe and active Graves' ophthalmopathy (GO). We aimed to investigate the response rate of methylprednisolone (MPD) treatment among Korean patients with active moderate-to-severe GO and to identify predictive factors of treatment response.

METHODS:

This is a retrospective observational study. We included 54 active moderate-to-severe GO patients treated with 4.5 g intravenous MPD over 12 weeks between November 2011 and November 2018. Response was defined as an improvement in at least two of five indicators (clinical activity score [CAS], soft-tissue involvement, exophthalmos, diplopia, and visual acuity) at immediate and 3 months after treatment completion. We examined predictive factors for response using logistic regression analysis.

RESULTS:

Twenty-four (44.4%) and 22 (40.7%) patients showed response at immediate and 3 months after intravenous (IV) steroid treatment. Of the five ophthalmic parameters, all patients in the responsive group (100.0%) showed a decrease in CAS and 90.9% showed less soft tissue involvement after IV steroid treatment. Among variables, the sum of extraocular muscle width was positively (odds ratio [OR], 1.163; 95% confidence interval [CI], 0.973-1.389; P = 0.096) associated with treatment response. While, the OR of age was 0.918 (95% CI, 0.856-0.985; P = 0.017) and thyrotropin binding inhibitory immunoglobulin (TBII) was 0.921 (95% CI, 0.864-0.982; P = 0.012).

CONCLUSION:

In Korean active moderate-to-severe GO patients, intravenous steroid treatment is not as effective as previously reported. Parameters associated with CAS and soft-tissue involvement were found to be influenced by IV MPD treatment. Extraocular muscle enlargement, younger age and lower TBII are predictive factors for a good steroid treatment response.

• Authors: Hwa Young Ahn, Jeong Kyu Lee
• Journal: Journal of Korean medical science (J Korean Med Sci) Vol. 35 Issue 23 Pg. e177 (Jun 15 2020) ISSN: 1598-6357 [Electronic] Korea (South)
• PMID: 32537950 (Publication Type: Journal Article)
• Copyright: © 2020 The Korean Academy of Medical Sciences.

Chemical References

• Glucocorticoids
• Immunoglobulins, Thyroid-Stimulating
• thyrotropin-binding inhibitory immunoglobulin

Topics

• Administration, Intravenous
• Adult
• Digestive System Diseases (etiology)
• Diplopia (pathology)
• Female
• Glucocorticoids (adverse effects, therapeutic use)
• Graves Ophthalmopathy (drug therapy, pathology)
• Humans
• Immunoglobulins, Thyroid-Stimulating (metabolism)
• Logistic Models
• Male
• Middle Aged
• Odds Ratio
• Republic of Korea
• Retrospective Studies
• Severity of Illness Index
• Treatment Outcome
• Visual Acuity