Treatment of severe
Graves' ophthalmopathy (GO) is a complex therapeutic challenge and, in spite of any efforts, about one third of patients are disappointed with the outcome of treatment.
Glucocorticoids (GC), orbital
radiotherapy (RT), or a combination of both, are most frequently used for their immunosuppressive effects. Novel immunosuppressive treatment procedures (or novel modalities of established treatments) are reviewed in the present article. GC has recently been used by the i.v. route and this treatment modality has been shown to be more effective and better tolerated than the oral route. Promising preliminary results have been reported by some authors with
somatostatin analogs,
octreotide and
lanreotide. The number of patients treated so far is limited, most of the results have been obtained in nonrandomized or uncontrolled studies, and comparison with other validated methods of treatment is also needed. Because of the pathogenic role of
cytokines,
cytokine antagonists, currently evaluated in other
autoimmune diseases, have been tested with positive results also in a small series of GO patients. The use of
antioxidants might also be envisioned in the future, since in vitro studies have shown that
oxygen free radicals might be involved in GO. Based on the shared
antigen(s) theory, total thyroid ablation, by removing the bulk of shared
antigens(s), might be beneficial for the course of GO. New data on recently performed placebo-controlled studies on orbital
radiotherapy are discussed, together with studies on long-term safety of orbital
radiotherapy.