TY - JOUR
T1 - Does early response to intravenous glucocorticoids predict the final outcome in patients with moderate-to-severe and active Graves’ orbitopathy?
AU - Bartalena, L.
AU - Veronesi, G.
AU - Krassas, G. E.
AU - Wiersinga, W. M.
AU - Marcocci, C.
AU - Marinò, M.
AU - Salvi, M.
AU - Daumerie, C.
AU - Bournaud, C.
AU - Stahl, M.
AU - Sassi, L.
AU - Azzolini, C.
AU - Boboridis, K. G.
AU - Mourits, M. P.
AU - Soeters, M. R.
AU - Baldeschi, L.
AU - Nardi, M.
AU - Currò, N.
AU - Boschi, A.
AU - Bernard, M.
AU - von Arx, G.
AU - Perros, P.
AU - Kahaly, G. J.
AU - on behalf of the European Group on Graves’ Orbitopathy (EUGOGO)
PY - 2017/5/1
Y1 - 2017/5/1
N2 - 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.
AB - 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.
KW - Clinical Activity Score
KW - Cyclosporine
KW - Graves’ orbitopathy or ophthalmopathy
KW - Intravenous glucocorticoids
KW - Orbital radiotherapy
KW - Shared decision-making
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U2 - 10.1007/s40618-017-0608-z
DO - 10.1007/s40618-017-0608-z
M3 - Article
C2 - 28176220
AN - SCOPUS:85017571563
VL - 40
SP - 547
EP - 553
JO - Journal of Endocrinological Investigation
JF - Journal of Endocrinological Investigation
SN - 0391-4097
IS - 5
ER -