What is the aim of immunosuppressive treatment in patients with graves' orbitopathy?
OBJECTIVE
The EUGOGO criteria and the clinical activity score (CAS) have been used as outcome measures to report response rates for patients after pulsed intravenous methylprednisolone (PIM) therapy. This study compares the results after PIM for both criteria and evaluates the number of rehabilitative surgeries performed in relation to treatment outcome.


METHODS
This was a retrospective review of patients with active moderate-to-severe Graves' orbitopathy (GO) treated with PIM (cumulative dose of 4.5 to 5 g). The EUGOGO criteria or improvement in CAS (≥2 points) was used as the primary outcome measure. Baseline characteristics were examined to evaluate any determinants of treatment response. Additional immunosuppressive therapy after PIM and rehabilitative surgical procedures for all patients within a 2-year period were also recorded.


RESULTS
Thirty-two patients were identified. Using the EUGOGO criteria, an improvement was seen in 38%, no change (stabilization) in 47%, and worsening of the disease in 15%. The response rate using the CAS was 63%. According to the EUGOGO criteria and the CAS, 20% (4/20) and 33% (4/12) of nonresponders required additional immunosuppressive treatment after PIM. None of the responders required additional immunosuppressive therapy. There was a reduction of 0.5 surgeries per patient for responders using either outcome measures.


CONCLUSIONS
In this study, PIM alone stabilizes active GO in 85% and reduces the severity of GO in 38% of the patients. Despite incongruent response rates obtained using the EUGOGO criteria and the CAS, both outcome measures were good predictors for additional immunosuppressive treatment and additional rehabilitative surgeries in nonresponders.
*Orbital Center, and †Department of Endocrinology & Metabolism, Academic Medical Center, University of Amsterdam, the Netherlands; and ‡Oculoplastic Service, Singapore National Eye Centre, Singapore.
Morgan
M
Yang
Wilmar M
WM
Wiersinga
Maarten R
MR
Soeters
Maarten P
MP
Mourits
D005260:Female; D049970:Graves Ophthalmopathy / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007262:Infusions, Intravenous; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D009916:Orbital Diseases / Q000188:drug therapy* / Q000503:physiopathology; D020551:Pulse Therapy, Drug; D012189:Retrospective Studies; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D008775:Methylprednisolone