Treatment of Graves' ophthalmopathy with high-dose intravenous methylprednisolone: a comparison of two dosing regimens.
OBJECTIVE
The treatment of active moderate-severe Graves' ophthalmopathy (GO) is based on the administration of highdose intravenous glucocorticoids. The present study compares the efficacy and safety of 2 different intravenous methylprednisolone (MTPiv) dosing regimens.


METHODS
We carry a retrospective descriptive study with sequential sampling of 24 patients (83% females) presenting moderatesevere GO (EUGOGO criteria) and receiving treatment in our center between January 2006 and June 2008. We use 2 dosing regimens: regimen A (12 weeks): 6 doses of 0.5g/week followed by 6 doses of 0.25 g/week, for a cumulative dose of 4.5 g of MTPiv (n=13); and regimen B (16 weeks): 4 cycles of 15 mg/kg, followed by 4 cycles of 7.5mg/kg, for a cumulative dose of 90 mg/kg (range, 4.9-7.4 g) (n=11). Comparisons were made for safety (fasting glucose, cytolysis-cholestasis enzymes, lipid profile) and efficacy data (clinical improvement and recurrence).


RESULTS
Mild-moderate liver cytolysis was recorded in four patients, one with associated moderate cholestasis and another with hyperglycemia, leading to treatment suspension - with no differences between the 2 treatment regimens. Percentage clinical improvement with regimen A was 92% (CI, 65-94%) versus 100% with regimen B (CI, 74-100%). The recurrence rate was 43% with regimen A and 63% with regimen B (p>0.05). None of the variables examined in the univariate logistic regression study were associated to a lesser treatment response or increased risk of recurrence of GO.


CONCLUSIONS
The treatment of GO with MTPiv is safe and effective, with a lower recurrence rate when using dosing regimen A.
Sánchez-Ortiga
Ruth
R
Endocrinology Department, Alicante General Universitary Hospital, Alicante, Spain.
Moreno-Pérez
Oscar
O
González Sánchez
Víctor
V
Arias Mendoza
Nieves
N
Mauri Dot
Montserrat
M
Alfayate Guerra
Rocío
R
López Macia
Alicia
A
Picó Alfonso
Antonio
A
D000328:Adult; D000368:Aged; D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology / Q000209:etiology; D004334:Drug Administration Schedule; D005260:Female; D049970:Graves Ophthalmopathy / Q000188:drug therapy*; D050031:Hashimoto Disease / Q000188:drug therapy; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced / Q000453:epidemiology; D007262:Infusions, Intravenous; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D020551:Pulse Therapy, Drug; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
D008775:Methylprednisolone