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Does early response to intravenous glucocorticoids predict the final outcome in patients with moderate-to-severe and active Graves’ orbitopathy?

Lookup NU author(s): Dr Petros Perros

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Abstract

© 2017, Italian Society of Endocrinology (SIE). Purpose: Intravenous glucocorticoids (ivGCs) given as 12-weekly infusions are the first-line treatment for moderate-to-severe and active Graves’ orbitopathy (GO), but they are not always effective. In this study, we evaluated whether response at 6 weeks correlated with outcomes at 12 (end of intervention) and 24 (follow-up) weeks, particularly in patients initially unresponsive. Methods: Our database (Bartalena et al. J Clin Endocrinol Metab 97:4454–4463, 10), comprising 159 patients given three different cumulative doses of methylprednisolone (2.25, 4.98, 7.47 g) was analyzed, pooling data for analyses. Responses at 6 weeks were compared with those at 12 and 24 weeks using three outcomes: overall ophthalmic involvement [composite index (CI)]; quality of life (QoL); Clinical Activity Score (CAS). Responses were classified as “Improved”, “Unchanged”, “Deteriorated”, compared to baseline. Results: Deteriorated patients at 6 weeks for CI (n = 8) remained in the same category at 12 weeks and 7/8 at 24 weeks. Improved patients at 6 weeks for CI (n = 51) remained in the same category in 63% and 53% of cases at 12 and 24 weeks, respectively. Unchanged patients at 6 weeks (n = 100) eventually improved in 28% of cases (CI), 58% (CAS), 32% (QoL). There was no glucocorticoid dose-dependent difference in the influence of early response on later outcomes. Conclusions: Patients who deteriorate at 6 weeks after ivGCs are unlikely to benefit from continuing ivGCs. Patients unresponsive at 6 weeks still have a significant possibility of improvement later. Accordingly, they may continue ivGC treatment, or, alternatively, possibly stop ivGCs and be switched to a second-line treatment.


Publication metadata

Author(s): Bartalena L, Veronesi G, Krassas GE, Wiersinga WM, Marcocci C, Marino M, Salvi M, Daumerie C, Bournaud C, Stahl M, Sassi L, Azzolini C, Boboridis KG, Mourits MP, Soeters MR, Baldeschi L, Nardi M, Curro N, Boschi A, Bernard M, von Arx G, Perros P, Kahaly GJ

Publication type: Article

Publication status: Published

Journal: Journal of Endocrinological Investigation

Year: 2017

Volume: 40

Issue: 5

Pages: 547-553

Print publication date: 01/05/2017

Online publication date: 07/02/2017

Acceptance date: 02/01/2017

ISSN (print): 0391-4097

ISSN (electronic): 1720-8386

Publisher: Springer International Publishing

URL: https://doi.org/10.1007/s40618-017-0608-z

DOI: 10.1007/s40618-017-0608-z


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