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

L. Bartalena, G. Veronesi, G. E. Krassas, W. M. Wiersinga, C. Marcocci, M. Marinò, M. Salvi, C. Daumerie, C. Bournaud, M. Stahl, L. Sassi, C. Azzolini, K. G. Boboridis, M. P. Mourits, M. R. Soeters, L. Baldeschi, M. Nardi, N. Currò, A. Boschi, M. BernardG. von Arx, P. Perros, G. J. Kahaly, on behalf of the European Group on Graves’ Orbitopathy (EUGOGO)

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)547-553
Number of pages7
JournalJournal of Endocrinological Investigation
Volume40
Issue number5
DOIs
Publication statusPublished - May 1 2017

Keywords

  • Clinical Activity Score
  • Cyclosporine
  • Graves’ orbitopathy or ophthalmopathy
  • Intravenous glucocorticoids
  • Orbital radiotherapy
  • Shared decision-making

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Fingerprint Dive into the research topics of 'Does early response to intravenous glucocorticoids predict the final outcome in patients with moderate-to-severe and active Graves’ orbitopathy?'. Together they form a unique fingerprint.

Cite this