title: Comparison of methimazole/hydrocortisone ointment with oral methimazole in patients with graves disease: A prospective, randomized, open-label, parallel-group, 18-month study.
abstract: BACKGROUND
  Thionamide antithyroid drugs (ATDs) have certain disadvantages and are associated with some adverse events (AEs). To overcome the problems associated with ATDs, a compound antithyroid ointment (CATO) containing methimazole (MMI) and hydrocortisone has been developed for use as a local thyroid treatment (LTT).
  
  
  OBJECTIVE
  The aim of this study was to assess the clinical effectiveness and tolerability of CATO LTT in patients with Graves disease (GD).
  
  
  METHODS
  This was a prospective, randomized, open-label, parallel-group clinical trial conducted at the Provincial Hospital Affiliated to Shandong University (Jinan, China). Patients with GD aged 19 to 65 years were randomized to receive either CATO LTT 0.3 g/d or oral MMI 37.5 mg/d (control group) treatment for 18 months, with a 4-year follow-up period. Hyperthyroid symptoms, thyroid function, granulocyte count, liver function, and AEs were assessed at baseline and every 2 weeks until serum thyroid hormone (TH) concentration normalized, at which point patients were assessed monthly. The primary efficacy end points were the duration of treatment required for serum TH concentration to normalize and the remission rate after completing the 18-month treatment regimen.
  
  
  RESULTS
  A total of 154 patients (133 women, 21 men; mean [SD] age, 39.6 [11.8] years; all Han Chinese) participated in the study; all patients completed the 18-month treatment period. Compared with the MMI group (n 76), the CATO- treated group (n 78) had a significantly shorter median (range) time to restoration of normal serum thyroid hormone concentration (43 [12-150] vs 22 [7-60] days; P < 0.001), a significantly lower rate of recurrence of hyperthyroidism (309/1520 [20.3%] vs 193/1368 [14.1%] person-time; P < 0.001), a significantly lower drug hypothyroidism rate (185/1520 [12.2%] vs 54/1368 [3.9%] person-time; P < 0.001), and a higher remission rate (year 1:46/69 [66.7%] vs 65/72 [90.3%] patients, P 0.001; year 2:40/69 [58.0%] vs 60/72 [83.3%] patients, P - 0.001; year 3:34/69 [49.3%] vs 57/72 [79.2%] patients, P < 0.001; and year 4:30/69 [43.5%] vs 55/72 [76.4%] patients, P < 0.001). Systemic AEs occurred in 6 patients (7.9%) in the MMI group (drug neutropenia, 2 patients [2.6%]; epistaxis, 1 [1.3%]; hepatopathy, 1 [1.3%]; and other systemic AEs, 2 [2.6%]), while no systemic AEs were observed/reported in the CATO group.
  
  
  CONCLUSIONS
  This study suggests that CATO LTT was well tolerated and more effective than oral MMI treatment in controlling thyrotoxicosis and promoting remission of GD in these Han Chinese patients.
authors.affiliation: Division of Endocrinology, Provincial Hospital Affiliated to Shandong University, Jinan, China.
authors.forename: Ling
authors.initials: L
authors.lastname: Chen
authors.affiliation: Gynecology and Obstetrical Department, Provincial Hospital Affiliated to Shandong University, Jinan, China.
authors.forename: Hong-Qing
authors.initials: HQ
authors.lastname: Wang
authors.affiliation: Division of Endocrinology, Affiliated Hospital of Qing Dao University, Qing Dao, China.
authors.forename: Yan-Yan
authors.initials: YY
authors.lastname: Gao
authors.affiliation: Division of Endocrinology, Xuzhou Central Hospital, Xuzho, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Liang
authors.affiliation: Health Department of Dezhou Peoples' Hospital, Dezhou, China.
authors.forename: Men
authors.initials: M
authors.lastname: Wang
authors.affiliation: Division of Endocrinology, Liaocheng Peoples' Hospital, Liaocheng, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Bai
authors.affiliation: Division of Endocrinology, Taian Central Hospital, Taian, China.
authors.forename: Wen-Bo
authors.initials: WB
authors.lastname: Qi
authors.affiliation: Division of Endocrinology, Provincial Hospital Affiliated to Shandong University, Jinan, China.
authors.forename: Jun-Sheng
authors.initials: JS
authors.lastname: Zhang
authors.affiliation: Medicament Department, Provincial Hospital Affiliated to Shandong University, Jinan, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Medicament Department, Provincial Hospital Affiliated to Shandong University, Jinan, China.
authors.forename: Juan-Qing
authors.initials: JQ
authors.lastname: Ren
authors.affiliation: Department of Epidemiology, Shandong Academy of Medical Science, Jinan, China.
authors.forename: Hui-Qing
authors.initials: HQ
authors.lastname: Li
keywords: antithyroid drugs; hyperthyroidism; ointment; transdermal administration; treatment