Endocrine Abstracts

The aim of the study was to compare efficacy and tolerability of systemic corticotherapy alone to corticotherapy combined with orbital radiotherapy in severe active Graves’ ophthalmopathy. We studied 905 patients, aged 35–73 years (mean 58.2 ±12), with clinical activity score above 4 and ATA class 3c to 6. Therapeutic outcome was assessed by change in ophthalmopathy index. For 4 weeks all subjects received corticotherapy: 869 - oral prednisone 60–100 mg daily and 36 patients with optic neuropathy -methylprednisolone iv 1000 mg for 7 days followed by oral glucocorticoids. Afterwards the subjects were randomized to group 1 (331 cases) – receiving gradually reduced corticoids for 20 weeks and group 2 (574 cases) - treated with glucocorticoids and retrobulbar megavoltage orbital radiotherapy of 20Gy. Corticotherapy alone resulted in significant reduction of ophthalmopathy index (7.4 vs. 4.4; P<0.001) with special effectiveness on soft tissue and optic nerve (80%, 81% of patients respectively) and unimpressive proptosis diminution and ocular motility improvement (52%, 50% respectively). In group 2 ophthalmopathy index decreased similarly (8.0 vs 4.7; P<0.001). Recurrence rate of severe phase during the first year of follow-up was 54% in group 1 and 15% in group 2. In those cases courses of cortiocotherapy were repeated. Side effects occurred in 42% patients during the first course of corticotherapy and in 59% during repeated courses (P<0.001). In particular, diabetes occurred in 13% of cases. Early postradiation exacerbation of soft tissue inflammation was noticed in 15.5% of patients. The combined therapy enabled reduction of treatment time by 30% and glucocorticoid dosage by 50%. We conclude that, compared to glucocorticoids alone, corticotherapy combined with orbital radiotherapy results in a better long-term effectiveness and tolerability in treatment of severe active Graves’ ophthalmopathy.