title: Effect of high dose methylprednisolone pulse therapy followed by oral prednisolone administration on the production of anti-TSH receptor antibodies and clinical outcome in Graves' disease.
abstract: Little is known about the immunosuppressive effect of glucocorticoids on TSH receptor antibodies. We observed the long-term prognosis and serum TSH binding inhibitor immunoglobulin (TBII) levels in patients with Graves' ophthalmopathy who had received intravenous methylprednisolone pulse therapy (pulse therapy) followed by oral prednisolone administration in order to ascertain how long the immunosuppressive effect of glucocorticoids continued. This is the first report on the effect of pulse therapy on Graves' disease outcome. We observed 67 patients who were treated by antithyroid drugs (ATD) alone for 2 years after pulse therapy. TBII was evaluated before and 3, 6, 12, 18, and 24 months after pulse therapy. The mean TBII decreased significantly 3 months after pulse therapy (p<0.001), and was maintained until 24 months. There were 24 patients whose TBII was positive (>15%) at 24 months, in whom the mean TBII decreased significantly 3 to 6 months after pulse therapy (p<0.001), but increased again at 12 to 24 months (p<0.05). Thus, the immunosuppressive effect of glucocorticoids may be lost at 12 months after pulse therapy in these patients. The remission rate in the pulse therapy group was 40.98%, and that of the control patient group was 48.57%. There was no significant difference between the two. These results suggest that the immunosuppressive effect of pulse therapy was temporary, and that pulse therapy did not increase remission rate of Graves' disease.
authors.affiliation: Kuma Hospital, Kobe, Japan.
authors.forename: Sumihisa
authors.initials: S
authors.lastname: Kubota
authors.forename: Hidemi
authors.initials: H
authors.lastname: Ohye
authors.forename: Eijun
authors.initials: E
authors.lastname: Nishihara
authors.forename: Takumi
authors.initials: T
authors.lastname: Kudo
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Ito
authors.forename: Shuji
authors.initials: S
authors.lastname: Fukata
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Amino
authors.forename: Kanji
authors.initials: K
authors.lastname: Kuma
authors.forename: Akira
authors.initials: A
authors.lastname: Miyauchi
mesh_terms: D000284:Administration, Oral; D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D016022:Case-Control Studies; D005260:Female; D006111:Graves Disease / Q000097:blood / Q000188:drug therapy* / Q000276:immunology*; D049970:Graves Ophthalmopathy / Q000097:blood / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D018828:Immunoglobulins, Thyroid-Stimulating; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000627:therapeutic use; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage* / Q000627:therapeutic use; D020551:Pulse Therapy, Drug; D011989:Receptors, Thyrotropin / Q000097:blood*; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001323:Autoantibodies; D018828:Immunoglobulins, Thyroid-Stimulating; D011989:Receptors, Thyrotropin; C094372:thyrotropin-binding inhibitory immunoglobulin; D007073:Immunoglobulin E; D011239:Prednisolone; D008775:Methylprednisolone