ECE2013 Poster Presentations Thyroid (non-cancer) (100 abstracts)
Efficacy and safety of combined parenenteral and oral steroid therapy in Graves' orbitopathy
Biljana Beleslin 1 , Jasmina Ciric 1 , Milos Zarkovic 1 , Miroslav Knezevic 2 , Mirjana Stojkovic 1 , Tijana Lalic 1 , Tanja Nisic 1 & Boza Trbojevic 1
1Clinic for Endocrinology, Clinical Center of Serbia, Belgrade, Serbia; 2Clinic for Ophtalmology, Clinical Center of Serbia, Belgrade, Serbia.
Introduction: Glucocorticoids (GC) are the first line treatment for moderate-to-severe and active Graves’ orbitopathy (GO), but optimal treatment is still undefined. The aim of the present study was to analyze the efficacy and tolerability of combined parenteral GC pulse therapy followed by oral GC in the interpulse period.
Methods: The study includes 50 patients (48±10 years; 37 females) with untreated, active and moderate-to-severe GO. Patients received 500 mg methylprednisolone in 500 ml physiologic saline followed by oral prednisone tapering dose and repeated each month for the next 5 months. Ophthalmic assessment was performed before and 6 months after treatment. Side effects of GC therapy were evaluated and recorded each month.
Results: GC showed the greatest effectiveness on soft tissue changes (incorporated in the CAS). Median CAS values decreased from 4.5 to 2.0 (P>0.001). Thirty-seven patients (74%) demonstrated improvement, there was no change in 13 (26%) patients, and none of the patients presented with deterioration of inflammatory status. Diplopia improved in 21 (42%) patients, was unchanged in 28 (56%) patients, and deteriorated in 1 (2%) patients. There was no significant change in the mean values of proptosis (P=NS) at the end of treatment. Improvement in optic neuropathy occurred in 56% of patients. At 6 months, 33/50 patients (66%) demonstrated overall treatment response. Side effects occurred in 35/50 (70%) patients, and vast majority of them were mild and minor. Weight gain and hirsutismus were the most common side effects.
Conclusion: With appropriate selection of patients and careful monitoring during and after treatment, combined parenteral and oral GC therapy is effective and safe.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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