Endocrine Abstracts

According to the recommendations of the European Group for the study of Graves ‘orbitopathy (EOP) (EUGOGO), pulse therapy with glucocorticosteroids, is the method of choice in active EOP of moderate severity or severe course. The choice of scheme depends largely on the doctor’s preferences, as the comparative effectiveness of many of them remains uncertain.

Objective: To evaluate the effectiveness of various schemes of pulse therapy with methylprednisolone in patients with EOP.

Methods: The study included 48 patients with moderate and severe forms of EOP in the active stage (CAS≥3), the average age 54.77±13.78 years. Patients of the 1st group (n=4) received methylprednisolone acetate (MP) at a dose of 1000 mg intravenously daily for 3 days. Patients of group 2 (n=36) received MP continuously for 5–7 days, at a dose of 1000 mg intravenously. Patients of group 3 (n=8) received MP at a dose of 1000 mg intravenously for 3 days, after 3 days – a repeated cycle of triple daily administration of MP at a dose of 1000 mg intravenously. The total dose of GCS in all groups did not exceed 8 g. Assessment of the degree of EOP activity was carried out on the CAS scale. Clinically significant effect was considered to be a decrease in activity on the CAS scale > 2 points. The severity of ophthalmopathy was assessed according to the EUGOGO classification.

Results: Before therapy, the median CAS in the 1st group was 5.5 points [3,5;6,75], in the 2nd group 5 points [4,2;6,1], in the 3rd group 6.5 points [6,3;9,5]. 1 week after the end of pulse therapy, the median score on the CAS scale in patients of group 1 was 3.5 [2.25;4.75], and in group 2 and 3 3.3 [2.2;4.1] and 3.1 [2.3;5.25], respectively. Significant effect was recorded in the 2nd (P<0.05) and 3rd (P<0.01) groups.

Conclusions: There was no significant effect in patients who received intravenous injections of MP daily for three days. In the group with continuous administration of MP in a total dose of 5–7 grams there was a decrease in the activity of EOP a week after the end of therapy. In patients with high activity using of MP in intermittent mode, in a total dose of 6 grams, leads to a decrease in the activity of ophthalmopathy within a week after the end of therapy.