Lookup NU author(s): Dr Petros Perros
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© 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.
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
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
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