Endocrine Abstracts

Objective: Whether additional immunosuppressive drugs to standard treatment with thyreostatic drugs reduce the risk for relapse in Graves’ disease is not well understood. We performed a systematic review and meta-analysis to study the effects of immunosuppressive drugs on relapse rate and treatment effect of patients with hyperthyroidism due to Graves’ disease.

Methods: We searched PubMed, EMBASE and Cochrane in July 2015 for randomized-controlled trials [RCT] comparing immunosuppressive drugs including corticosteroids, rituximab and azathioprine in patients with Graves’ disease. We did not restrict the electronic searches for trials by date or language. The primary endpoint was relapse of disease until follow-up, secondary endpoints were reduction of thyroid volume and TSH-receptor-antibodies [TRAb].

Results: We included 7 RCTs with a total of 862 participants. Trials were mostly small with moderate to high risk for bias. There were 113 relapses in 481 patients receiving immunosuppressants compared to 225 relapses in 381 patients (RR for recurrence of 0.39, 95% confidence interval [CI] 0.21, 0.71). There was also a significant risk reduction found for patients in RCT (0.28 RR, 95% CI 0.18, 0.46), whereas the pooled data for controlled trials showed only a trend (0.54 RR, 95% CI 0.26, 1.13). There was a significant reduction of thyroid volume (−10.61ml, 95% CI −15.48, −5.75) and TRAb levels (−17.01 U/L, 95% CI −33.31, −0.72).

Conclusions: We found a significant reduction in relapse when immunosuppressive drugs were added to standard treatment, although the number of the trials was small with high heterogeneity in regard to type of drugs used.