The use of corticosteroids versus other treatments for Graves' ophthalmopathy: a quantitative evaluation

The purpose of the present study was to evaluate the efficacy of corticosteroids in the treatment of Graves' ophthalmopathy in comparison to other treatment modalities.

15 studies were identified but only 14 were included in the final analysis, 5 cohort and 9 randomized. A total of 813 patients were included in this quantitative review.

The relative risk with oral corticosteroid treatment (OCS) alone vs. other treatment could not be pooled, as the studies were heterogeneous and the RR was dependent on risk of failure in the control group. In the two studies that reported head-on comparison between OCS and radiotherapy, no clinically significant difference was found. However, the combination of OCS and radiotherapy was markedly more effective than either modality alone (pooled RRR 70%). The number of patients who should be treated with the combination of CS and radiotherapy to prevent one more failure was between 3 to 8. Evidence from the studies suggest that intravenous corticosteroid's IVCSs used alone have similar or greater efficacy than the combination.

Corticosteroids seem to be an effective treatment for Graves' ophthalmopathy compared to other treatments currently available. Oral corticosteroids appear to have increased effect when given with radiotherapy. IVCSs, with or without radiotherapy, seem to have the best documented efficacy. Side effects can also be overcome by the use of IVCS pulse therapy (without OCS), which needs to be pursued in further, separate research as an alternative to oral therapy, since it could be both more effective and safer.