title: Common Immunosuppressive Monotherapy for Graves' Ophthalmopathy: A Meta-Analysis.
abstract: BACKGROUND
  Several immunosuppressive therapeutic regimens are widely used to treat Graves' ophthalmopathy (GO), including oral glucocorticoids (OGC), intravenous glucocorticoids (IVGC), retrobulbar injections of glucocorticoids (ROGC) and orbital radiotherapy (OR). The priority among these is unknown. This meta-analysis investigated the efficacy and tolerability of the above regimens.
  
  
  METHODS
  The PubMed, EMBASE, and Cochrane Library databases and the Chinese Biomedicine Database were searched up to November 18, 2014. Randomized controlled trials (RCTs) comparing monotherapies (OGC, IVGC, ROGC and OR) in patients with moderate-to-severe active GO were selected. The main efficacy measures were the response rate, the standard mean difference (SMD) in the reduction in the clinical activity score (CAS) and the mean difference (MD) in proptosis from baseline to the end of treatment. The main tolerability measure was the risk ratio (RR) for adverse events. The pooled estimates and 95% confidence intervals (95% CIs) were calculated using the RevMan software, version 5.1.
  
  
  RESULTS
  Seven published RCTs involving 328 participants were included in the present meta-analysis, including IVGC versus OGC (3 trials), ROGC versus OGC (3 trials) and OR versus OGC (1 trial). IVGC was more effective than OGC in response rate (RR = 1.48, 95% CI = 1.18-1.87) and had an obvious CAS reduction (SMD = 0.69, 95% CI = 0.13-1.25). IVGC caused fewer adverse events than OGC. ROGC and OGC had no statistically significant difference in response rate (RR = 1.16, 95% CI = 0.94-1.42). OR also did not differ significantly compared with OGC (RR = 0.93, 95% CI = 0.54-1.60). ROGC and OR had fewer adverse events, such as weight gain, compared with OGC.
  
  
  CONCLUSIONS
  For patients with GO in the moderate-to-severe active phase, current evidence gave priority to IVGC, which had a statistically significant advantage over OGC and caused fewer adverse events. ROGC and OR did not provide greater efficacy than OGC, although better tolerability and fewer adverse events were shown.
authors.affiliation: Department of Ophthalmology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Pei
authors.initials: P
authors.lastname: Mou
authors.affiliation: Department of Ophthalmology, Shanghai Zhabei District Central Hospital, Shanghai, China.
authors.forename: Li-Hong
authors.initials: LH
authors.lastname: Jiang
authors.affiliation: Department of Ophthalmology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Ophthalmology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Yu-Zhen
authors.initials: YZ
authors.lastname: Li
authors.affiliation: Department of Ophthalmology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Heng
authors.initials: H
authors.lastname: Lou
authors.affiliation: Department of Ophthalmology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Cheng-Cheng
authors.initials: CC
authors.lastname: Zeng
authors.affiliation: Department of Ophthalmology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Qiu-Hong
authors.initials: QH
authors.lastname: Wang
authors.affiliation: Department of Ophthalmology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Jin-Wei
authors.initials: JW
authors.lastname: Cheng
authors.affiliation: Department of Ophthalmology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Rui-Li
authors.initials: RL
authors.lastname: Wei
mesh_terms: D002986:Clinical Trials as Topic; D049970:Graves Ophthalmopathy / Q000188:drug therapy* / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D012449:Safety; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents