Early use of steroid-sparing agents in the inactivation of moderate-to-severe active thyroid eye disease: a step-down approach.

Abstract

OBJECTIVES:

The current first-line treatment for management of active thyroid eye disease (TED) is high-dose intravenous corticosteroids, which have the potential for serious adverse effects. Our aim was to evaluate the effect of steroid-sparing agents (SSAs) in patients with moderate-to-severe active TED, using methotrexate as first-line.

METHODS:

Presented is a retrospective, four-year, single-centre, consecutive case series of patients with moderate-to-severe TED treated using the Oxford protocol. Treatment modality, disease activity, and adverse effects are reported at presentation, 6- and 12-month follow-up.

RESULTS:

104 consecutive TED patients treated by the Oxford TED team were reviewed. 24 patients with moderate-to-severe active disease were identified (mean age 46.8 years;12 female) with a mean pretreatment VISA inflammatory index score of 5.5/10 (SD = 1.98; range 1-9). Intravenous methyl-prednisolone (IVMP) and an SSA was commenced in all patients. Mean total steroid dose was 2.72 g (SD = 1.4;1.0-6.9). 38% of patients (n = 9) received ≤1.5 g of IVMP. Only two patients required >4.5 g of IVMP equating to the EUGOGO treatment protocol dose for this patient group. There was significant improvement in inflammatory index score both at the intermediate review (mean score 2.7; SD = 2.8; P < 0.001; mean follow up 25.2 weeks) and at one year or last follow-up (mean score 1.4; SD = 1.5; P < 0.001; mean follow up 48.0 weeks). No serious or long-term adverse effects were reported.

CONCLUSION:

This study suggests that the initiation of an SSA, using methotrexate as first-line, with limited adjuvant IVMP is an effective and safe treatment for moderate-to-severely active TED, resulting in a significant reduction in both disease activity and total steroid load.

• Authors: Zuzana Sipkova, Elizabeth A Insull, Joel David, Helen E Turner, Shay Keren, Jonathan H Norris
• Journal: Clinical endocrinology (Clin Endocrinol (Oxf)) Vol. 89 Issue 6 Pg. 834-839 (12 2018) ISSN: 1365-2265 [Electronic] England
• PMID: 30103255 (Publication Type: Journal Article)
• Copyright: © 2018 John Wiley & Sons Ltd.

Chemical References

• Abortifacient Agents, Nonsteroidal
• Methylprednisolone
• Methotrexate

Topics

• Abortifacient Agents, Nonsteroidal (therapeutic use)
• Adult
• Aged
• Aged, 80 and over
• Female
• Graves Ophthalmopathy (drug therapy)
• Humans
• Male
• Methotrexate (therapeutic use)
• Methylprednisolone (therapeutic use)
• Middle Aged
• Retrospective Studies