Comparison of Intravenous vs. Oral MethylprednisOlone Therapy
Comparison of Intravenous vs. Oral MethylprednisOlone Therapy
A prospective, randomised and single blind clinical trial was designed to compare intravenous methylprednisolone pulse (IVGC) with oral methylprednisolone (OGC) monotherapy in terms of effectiveness and tolerability in Graves' ophthalmopathy (GO). Fifty-two consecutive patients with untreated, moderately severe and active GO were randomly treated with either IVGC or OGC therapy for 12 weeks. IVGC therapy achieved a more rapid and significant improvement than OGC therapy according to clinical activity score (p < 0.01), proptosis (p < 0.038), lid width (p < 0.0001), extraocular muscle changes (p < 0.02), optic neuropathy. (p < 0.001), intraocular pressure (p < 0.04), visual acuity (p < 0.03), quality of life (p < 0.0001) and treatment response (p < 0.001). Diplopia was significantly improved in two groups but there was no difference between them (p < 0.6). Heavy smokers indicated alteration of ophthalmic signs with increased thyroid stimulating hormone (TSH)-receptor antibody during the therapy. In conclusion, IVGC therapy was more effective and better tolerated than OGC therapy in the management of GO.
Graves' ophthalmopathy (GO), an autoimmune disorder of the retrobulbar tissue, is closely linked to autoimmune thyroid disease. It is a disfiguring and invalidating disease that profoundly impairs the quality of life of affected individuals. Less than 5-10% patients with Graves' disease will develop clinically relevant, active and progressive orbital complications to require medical or surgical intervention. Treatment of this disease is difficult and often unsatisfactory. Glucocorticoids have been used for treatment of GO because of their anti-inflammatory and immunosuppressive actions during the active phase of GO. Many studies have documented a high effectiveness of high-dose oral glucocorticoids (OGC) on soft tissue changes and optic neuropathy, whereas the decrease in proptosis and the improvement ocular motility have not always been impressive. It has been reported that patients treated with high-dose intravenous glucocorticoid pulse therapy (IVGC) had a better outcome than those treated with OGC. However, IVGC was given in the interpulse periods, and followed by OGC treatment and/or orbital radiotherapy. These were not randomised and prospective studies. There was no study comparing directly the two modalities of GC administration, except that of Kahaly et al..
The aim of this study was to determine whether IVGC therapy was more effective than OGC therapy in the management of GO.
A prospective, randomised and single blind clinical trial was designed to compare intravenous methylprednisolone pulse (IVGC) with oral methylprednisolone (OGC) monotherapy in terms of effectiveness and tolerability in Graves' ophthalmopathy (GO). Fifty-two consecutive patients with untreated, moderately severe and active GO were randomly treated with either IVGC or OGC therapy for 12 weeks. IVGC therapy achieved a more rapid and significant improvement than OGC therapy according to clinical activity score (p < 0.01), proptosis (p < 0.038), lid width (p < 0.0001), extraocular muscle changes (p < 0.02), optic neuropathy. (p < 0.001), intraocular pressure (p < 0.04), visual acuity (p < 0.03), quality of life (p < 0.0001) and treatment response (p < 0.001). Diplopia was significantly improved in two groups but there was no difference between them (p < 0.6). Heavy smokers indicated alteration of ophthalmic signs with increased thyroid stimulating hormone (TSH)-receptor antibody during the therapy. In conclusion, IVGC therapy was more effective and better tolerated than OGC therapy in the management of GO.
Graves' ophthalmopathy (GO), an autoimmune disorder of the retrobulbar tissue, is closely linked to autoimmune thyroid disease. It is a disfiguring and invalidating disease that profoundly impairs the quality of life of affected individuals. Less than 5-10% patients with Graves' disease will develop clinically relevant, active and progressive orbital complications to require medical or surgical intervention. Treatment of this disease is difficult and often unsatisfactory. Glucocorticoids have been used for treatment of GO because of their anti-inflammatory and immunosuppressive actions during the active phase of GO. Many studies have documented a high effectiveness of high-dose oral glucocorticoids (OGC) on soft tissue changes and optic neuropathy, whereas the decrease in proptosis and the improvement ocular motility have not always been impressive. It has been reported that patients treated with high-dose intravenous glucocorticoid pulse therapy (IVGC) had a better outcome than those treated with OGC. However, IVGC was given in the interpulse periods, and followed by OGC treatment and/or orbital radiotherapy. These were not randomised and prospective studies. There was no study comparing directly the two modalities of GC administration, except that of Kahaly et al..
The aim of this study was to determine whether IVGC therapy was more effective than OGC therapy in the management of GO.
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