Background
Graves’ ophthalmopathy (GO) is an autoimmune disease of the orbit. Treatment for GO patients depends on the activity and severity of the eye changes. In patients with moderate-to-severe and active GO, intravenous (IV) glucocorticoid treatment is considered as a first-line treatment. However, response rates have been different depending on the dose of steroid or race. In addition, factors that predict the response of the treatment are not well known.
Method
This study was retrospective observational study. We included and analyzed 49 moderate-to severe and active GO patients who treated 4.5g IV methylprednisolone during 12 weeks from November 2011 to November 2018. The response was defined when two or more of the five indicators (CAS, soft tissue involvement, exophthalmos, lid width, diplopia) were improved 3 months after the end of treatment. We examined predictive factors for the response using logistic regression analysis.
Results
Twenty-three (46.9%) patients classified response group 3 months after IV steroid treatment. In multivariate logistic regression analysis, age was negatively associated with response (OR 0.865, 95% CI 0.753-0.994), width of superior rectus muscle was positively associated with response (OR 3.899, 95% CI 1.305-11.649). In addition, suppressive TSH (OR 0.012, 95% CI 0.000-0.832) and higher TSH binding inhibitory immunoglobulin (TBII, OR 0.766, 95% CI 0.622-0.943) were associated with negative response of IV steroid treatment. On the other hand, the larger change of TBII after IV steroid treatment was related to the response (OR 1.460, 95% CI 1.009-2.113). In our study, CAS and soft tissue involvement improved mainly by steroid treatment.
Conclusion
In Korean active GO patients, it seems that IV steroid treatment is not as effective as previously reported. Younger age, superior recuts muscle enlargement, normal TSH, lower TBII and higher changes of TBII after treatment are predictive factors for good response of IV steroid treatment.