Intravenous glucocorticoid treatment for Korean graves' ophthalmopathy patientsIntravenous Glucocorticoid Treatment for Korean Graves' Ophthalmopathy Patients
- Authors
- Ahn H.Y.; Lee J.K.
- Issue Date
- 15-Jun-2020
- Publisher
- Korean Academy of Medical Science
- Keywords
- Clinical activity score; Glucocorticoids; Graves' ophthalmopathy; Response rate
- Citation
- Journal of Korean Medical Science, v.35, no.23, pp 1 - 9
- Pages
- 9
- Journal Title
- Journal of Korean Medical Science
- Volume
- 35
- Number
- 23
- Start Page
- 1
- End Page
- 9
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/42717
- DOI
- 10.3346/JKMS.2020.35.E177
- ISSN
- 1011-8934
1598-6357
- Abstract
- Background: High-dose intravenous steroids are the first-line treatment for patients with moderate-to-severe and active Graves' ophthalmopathy (GO). We aimed to investigate the response rate of methylprednisolone (MPD) treatment among Korean patients with active moderate-to-severe GO and to identify predictive factors of treatment response. Methods: This is a retrospective observational study. We included 54 active moderate-to-severe GO patients treated with 4.5 g intravenous MPD over 12 weeks between November 2011 and November 2018. Response was defined as an improvement in at least two of five indicators (clinical activity score [CAS], soft-tissue involvement, exophthalmos, diplopia, and visual acuity) at immediate and 3 months after treatment completion. We examined predictive factors for response using logistic regression analysis. Results: Twenty-four (44.4%) and 22 (40.7%) patients showed response at immediate and 3 months after intravenous (IV) steroid treatment. Of the five ophthalmic parameters, all patients in the responsive group (100.0%) showed a decrease in CAS and 90.9% showed less soft tissue involvement after IV steroid treatment. Among variables, the sum of extraocular muscle width was positively (odds ratio [OR], 1.163; 95% confidence interval [CI], 0.973-1.389; P = 0.096) associated with treatment response. While, the OR of age was 0.918 (95% CI, 0.856-0.985; P = 0.017) and thyrotropin binding inhibitory immunoglobulin (TBII) was 0.921 (95% CI, 0.864-0.982; P = 0.012). Conclusion: In Korean active moderate-to-severe GO patients, intravenous steroid treatment is not as effective as previously reported. Parameters associated with CAS and soft-tissue involvement were found to be influenced by IV MPD treatment. Extraocular muscle enlargement, younger age and lower TBII are predictive factors for a good steroid treatment response. © 2020 The Korean Academy of Medical Sciences.
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