Comparison of Different Intravenous Glucocorticoid Protocols in the Treatment of Graves' Orbitopathy: Single-Center Experience

Öz

ABSTRACT Objective: To evaluate clinical data of patients receiving intravenous (IV) glucocorticoid treatment with the diagnosis of Graves' orbitopathy (GO) and to compare the treatment protocols. Material and Methods: We retrospectively examined the clinical and laboratory data of patients who received systemic glucocorticoid treatment for GO in our clinic. Group 1 (4 cycles of 15 mg/kg methylprednisolone in 2 doses every other day for 2 weeks apart, followed by 4 cycles of 7.5 mg/kg methylprednisolone at the same frequency (regimen A)) and Group 2 (500 mg methylprednisolone once a week for 6 weeks followed by 250 mg methylprednisolone once a week for 6 weeks (regimen B)) were formed. Group 1 and Group 2 data were compared. Results: A total of 36 patients were included in the study, 11 in group 1 and 25 in group 2. The average age of the patients was higher in group 1 than in group 2 (56±12.9 and 46.8±10.2, respectively, p=0.02). There was no difference between the groups in terms of gender distribution and the frequency of smokers. There was a history of another autoimmune disease in 20% of all patients. GO developed in the natural course of the disease in 88.9% of all patients, after radioactive iodine treatment in 8.3%, and after thyroid surgery in 2.8%. The clinical activity score (CAS) was found to decrease at a similar rate with treatment in both groups. In terms of, the European Group on Graves' Orbitopathy (EUGOGO) severity class, diplopia, soft tissue involvement, lid retraction, proptosis, and corneal damage, no statistically significant benefit was achieved with the treatment. Conclusion: Systemic intravenous glucocorticoid therapy is an effective treatment option to suppress inflammatory activity in GO patients who need systemic immunosuppressive therapy. The decrease in both groups of CAS was similar. The achievement of similar effects with a lower cumulative steroid dose supports the use of regimen B.

Anahtar Kelimeler

• Graves orbitopathy
• Exophthalmos
• Thyroid ophthalmopathy

Graves Orbitopatisi Tedavisinde Farklı İntravenöz Glukokortikoid Protokollerinin Karşılaştırılması: Tek Merkez Deneyimi

Öz

ÖZ Amaç: Graves orbitopatisi (GO) sebebi ile intravenöz (IV) glukokortikoid tedavisi alan hastaların klinik verilerini değerlendirmek ve kullanılan tedavi protokollerini karşılaştırmak. Gereç ve Yöntemler: Merkezimizde GO sebebi ile sistemik glukokortikoid tedavisi alan hastaların klinik ve laboratuvar verileri retrospektif olarak incelendi. Rejim A (15 mg/kg metilprednizolon 2 hafta ara ile gün aşırı 2 doz şeklinde 4 siklus, sonrasında aynı sıklıkta 7,5 mg/kg metilprednizolon 4 siklus) alanlarla grup 1, rejim B (6 hafta boyunca haftada 1 gün 500 mg metilprenizolonu takiben 6 hafta boyunca haftada 1 gün 250 mg metilprednizolon) alanlarla ise grup 2 oluşturuldu. Grup 1 ve grup 2 verileri birbiri ile karşılaştırıldı. Bulgular: Çalışmaya; 11’i grup 1’de, 25’i ise grup 2’de olmak üzere toplam 36 hasta alındı. Hastaların yaş ortalaması grup 1’de grup 2’ye oranla daha yüksekti (Sırası ile 56±12,9 ve 46,8±10,2, p=0,02). Cinsiyet dağılımı ve sigara içen hasta sıklığı yönünden ise gruplar arasında fark saptanmadı. Ek otoimmun hastalık öyküsü tüm hastaların %20’sinde vardı. GO’nun tüm hastaların %88,9’unda hastalığın doğal seyrinde, %8,3’ünde radyoaktif iyot tedavisi sonrası, %2,8’inde ise tiroid cerrahisi sonrası geliştiği saptandı. Klinik aktivite skorunun her iki grupta tedavi ile benzer oranda azaldığı saptandı. The European Group on Graves’ Orbitopathy (EUGOGO) ciddiyet sınıfı, diplopi, yumuşak doku tutulumu, kapak retraksiyonu, propitozis ve kornea hasarı yönünden yapılan değerlendirmede tedavi ile istatistiksel anlamlılığa ulaşan yarar sağlanmadığı saptandı. Sonuç : Sistemik intravenöz glukokortikoid tedavisi, immünsüpressif tedavi endikasyonu konulan GO hastalarında hastalık aktivitesini baskılama yönünden etkili bir tedavi seçeneğidir. Her iki grupta KAS düşüşü benzer saptanmıştır. Daha düşük kümülatif steroid dozu kullanılarak benzer etki elde edilmesi rejim B kullanımını destekler niteliktedir.

Anahtar Kelimeler

• Graves orbitopatisi
• Ekzoftalmus
• Tiroid oftalmopatisi

Kaynakça

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