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

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Bartalena, Luigi Veronesi, Giovanni Krassas, Gerasimos E. Wiersinga, Wilmar Maarten Marcocci, Claudio Daumerie, Chantal [UCL] Baldeschi, Lelio [UCL] Boschi, Antonella [UCL] Kahaly, George J.

(eng) 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.

Document type Article de périodique (Journal article) – Article de recherche
Publication date 2017
Language Anglais
Journal information "Journal of Endocrinological Investigation" - Vol. 40, no. 5, p. 547-553 (2017)
Peer reviewed yes
Publisher EditriceKurtis s.r.l. ((Italy) Milano)
issn 0391-4097
e-issn 1720-8386
Publication status Publié
Affiliations UCL - (SLuc) Service d'endocrinologie et de nutrition
UCL - SSS/IONS/NEUR - Clinical Neuroscience
UCL - (SLuc) Service d'ophtalmologie
UCL - SSS/IREC/EDIN - Pôle d'endocrinologie, diabète et nutrition
UCL - SSS/IONS - Institute of NeuroScience
Keywords Clinical Activity Score; Cyclosporine; Graves’ orbitopathy or ophthalmopathy; Intravenous glucocorticoids; Orbital radiotherapy; Shared decision-making
Links
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Bibliographic reference Bartalena, Luigi ; Veronesi, Giovanni ; Krassas, Gerasimos E. ; Wiersinga, Wilmar Maarten ; Marcocci, Claudio ; et. al. Does early response to intravenous glucocorticoids predict the final outcome in patients with moderate-to-severe and active Graves’ orbitopathy?. In: Journal of Endocrinological Investigation, Vol. 40, no. 5, p. 547-553 (2017)
Permanent URL http://hdl.handle.net/2078.1/188133