J Korean Med Sci.  2020 Jun;35(23):e177. 10.3346/jkms.2020.35.e177.

Intravenous Glucocorticoid Treatment for Korean Graves' Ophthalmopathy Patients

• Ahn HY
• Lee JK

• KMID: 2502920
• DOI: http://doi.org/10.3346/jkms.2020.35.e177

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.

Keyword

Graves' Ophthalmopathy; Glucocorticoids; Clinical Activity Score; Response Rate

Figure

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  Fig. 1 Number of patients according to treatment response at immediate and 3 months after 12 weeks intravenous steroid treatment. Five patients who responded immediately after IV steroid treatment changed to non-responders after 3 months, while three patients who did not respond immediately belonged to the responders after 3 months.

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  Fig. 2 Response rate of each indicator at 3 months after IV steroid treatment.(A) Response rate in responders. In responder, the response rate was 100% in CAS, 90.9% in NOSPECS class II, 27.3% in proptosis and diplopia and 18.1% in visual acuity. (B) Response rate in total subjects. In total subjects, the response rate was 44.4% in CAS, 40.7% in NOSPECS class II, 11.1% in proptosis and diplopia and 16.6% in visual acuity.CAS = clinical activity score, NOSPECS = N, No Symptoms or signs, O, Only symptoms, S, Soft tissue involvement, P, Proptosis, E, Extraocular muscle involvement, C, Corneal involvement, S, Sight loss due to optic nerve compression.

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