Intravenous glucocorticoids therapy in the treatment of Graves’ ophthalmopathy: a systematic review and Meta-analysis
Journal Title: International Journal of Ophthalmology - Year 2019, Vol 12, Issue 7
Abstract
"AIM: To evaluate the benefit and harms of high-dose intravenous glucocorticoids (IVGC) as first-line treatment for Graves’ ophthalmopathy (GO). METHODS: A systematic review and Meta-analysis of randomized clinical trials (RCTs) comparing IVGC for the treatment of GO, with placebo or other treatments, were conducted. Electronic databases were searched, and standard methodological guidance of Cochrane Handbook for Systematic Reviews of Interventions was used. The primary outcome was overall response, and secondary outcomes included the improvement and change in clinical activity score (CAS), and adverse events. RESULTS: Ten RCTs were included in the Meta-analysis. Low quality evidence (one trial) showed that participants receiving IVGC achieved significantly higher response compared to participants receiving placebo [risk ratio (RR) 7.50, 95% confidence interval (CI) 1.14 to 49.26]. Moderate quality evidence (four trials) support appreciable benefit of IVGC in response compared with oral glucocorticoids (OGC), with of RR being 1.51 (95%CI 1.25 to 1.83). There was low quality evidence (one trial) compatible with appreciable benefit for IVGC plus orbital radiotherapy in response (RR 1.38, 95%CI 1.07 to 1.79), compared with OGC plus orbital radiotherapy. One IVGC versus rituximab trial provided moderate quality evidence suggesting that participants using IVGC achieved significantly lower response compared to participants using rituximab (RR 0.70, 95%CI 0.50 to 0.98). One IVGC versus mycophenolate mofetil (MMF) trial provided moderate quality evidence suggesting that participants using IVGC achieved significantly lower response compared to participants using MMF (RR 0.74, 95%CI 0.63 to 0.88). Very low quality evidence (one trial) showed that participants with dysthyroid optic neuropathy (DON) receiving IVGC were more likely to achieve response compared to participants receiving orbital decompression (RR 3.33, 95%CI 0.51 to 21.89). CONCLUSION: The current evidence is moderate quality, which is sufficient to support IVGC to be as the first-line treatment for moderate-to-severe GO, and the use of rituximab or MMF to be the second-line treatment instead of IVGC. However, the evidence is very low quality, which is insufficient to support the use of IVGC or orbital decompression as the first-line treatment of DON."
Authors and Affiliations
Jin-Wei Cheng
Keywords
Related Articles
- EP ID EP648118
- DOI 10.18240/ijo.2019.07.20
- Views 69
- Downloads 0
Efficacy of autologous conjunctival flap on repairing the late-onset filtering bleb leakage
"AIM: To evaluate the effectiveness of autologous conjunctival flap surgery for repairing the late-onset filtering bleb leakage after trabeculectomy. METHODS: This study retrospectively reviewed 106 eyes from 106 patient...
Comment on “Anterior lamellar recession for management of upper eyelid cicatricial entropion and associated eyelid abnormalities”
Comment
Artificial intelligence on diabetic retinopathy diagnosis: an automatic classification method based on grey level co-occurrence matrix and naive Bayesian model
"AIM: To develop an automatic tool on screening diabetic retinopathy (DR) from diabetic patients. METHODS: We extracted textures from eye fundus images of each diabetes subject using grey level co-occurrence matrix metho...
Validation and reproducibility of the Heidelberg Edge Perimeter in the detection of glaucomatous visual field defects
"AIM: To validate the ability of the Heidelberg Edge Perimeter (HEP) in detecting glaucomatous visual field (VF) defects compared to the Octopus Visual Field (OVF) Analyzer and to determine the test-retest repeatability...
Abnormal resting-state functional network centrality in patients with high myopia: evidence from a voxel-wise degree centrality analysis
"AIM: To investigate the functional networks underlying the brain-activity changes of patients with high myopia using the voxel-wise degree centrality (DC) method. METHODS: In total, 38 patients with high myopia (HM) (17...