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Medium-dose intravenous methylprednisolone pulse therapy for thyroid-associated orbitopathy
Ashfaque Rahman Khan1, Sadia Sultana2, Riffat Rashid2
1Bangladesh Eye Hospital, Zigatola Ltd., Dhaka 1209, Bangladesh.
Aim:
To evaluate the efficacy and safety of a medium-dose intravenous methylprednisolone (IVMP) pulse regimen for moderate-to-severe active thyroid-associated orbitopathy (TAO), with change in clinical activity score (CAS) as the primary outcome.
Methods:
This prospective interventional study was conducted at a tertiary eye care center in Bangladesh between February and November 2022. Patients with active moderate-to-severe TAO (CAS≥3) received IVMP totaling 4.0 g (500 mg daily for 3 consecutive days, followed by 500 mg every 3wk for 5 cycles). Clinical outcomes, including CAS, proptosis measured by Hertel exophthalmometry, best-corrected visual acuity (BCVA; logMAR), and intraocular pressure (IOP), were assessed at baseline and at 6mo.
Results:
A total of 30 patients with active TAO were enrolled and completed the 6-month follow-up. The mean age of the participants was 38.63±12.11y, and 19 (63.3%) were male. The mean CAS decreased significantly from 3.66±1.03 to 0.87±0.63 (mean change -2.79±0.95; P<0.0001). The mean degree of proptosis decreased from 22.47±1.59 to 20.13±1.97 mm (-2.34±1.25 mm; P<0.0001). BCVA improved from 0.46±0.31 to 0.15±0.18 logMAR (-0.31±0.28; P=0.02). The mean IOP decreased from 16.80±3.56 to 14.93±1.73 mm Hg (-1.87±2.45 mm Hg; P<0.001). Eyelid swelling, conjunctival redness, chemosis, and retro-orbital pain resolved in more than 90% of patients. Adverse events, including transient increased IOP (26.66%), hyperglycemia (20.00%), and elevated SGPT (6.67%), were mild and reversible; no severe hepatic, cardiovascular, or psychiatric complications occurred.
Conclusion:
Medium-dose IVMP (4.0 g) significantly improve disease activity, proptosis, visual acuity, and IOP, with an acceptable safety profile. This regimen represents an effective and safer alternative to high-dose IVMP for active moderate-to-severe TAO, particularly in resource-limited settings. Larger, multicenter trials with longer follow-up periods are needed to confirm these findings.
Insights
Medium-dose intravenous methylprednisolone (IVMP) effectively treats active thyroid-associated orbitopathy (TAO), improving eye symptoms and vision. This safer IVMP regimen is a viable alternative for moderate-to-severe TAO cases.
Area of Science:
- Ophthalmology
- Endocrinology
- Immunology
Background:
- Thyroid-associated orbitopathy (TAO) is an autoimmune condition affecting the eye socket.
- Moderate-to-severe active TAO requires effective treatment to prevent vision loss and improve quality of life.
Purpose of the Study:
- To assess the efficacy and safety of a 4.0 g medium-dose intravenous methylprednisolone (IVMP) pulse regimen for active moderate-to-severe TAO.
- To evaluate changes in clinical activity score (CAS), proptosis, visual acuity, and intraocular pressure (IOP).
Main Methods:
- Prospective interventional study at a tertiary eye care center.
- 30 patients with active TAO (CAS≥3) received 4.0 g IVMP over 5 cycles.
- Outcomes including CAS, proptosis, BCVA, and IOP were measured at baseline and 6 months.
Main Results:
- Significant reduction in mean CAS (3.66 to 0.87) and proptosis (22.47 to 20.13 mm).
- Improvement in best-corrected visual acuity (BCVA) and decrease in intraocular pressure (IOP).
- Over 90% symptom resolution; mild, reversible adverse events like transient increased IOP and hyperglycemia.
Conclusions:
- Medium-dose IVMP (4.0 g) is effective and safe for moderate-to-severe active TAO.
- This regimen offers a safer alternative to high-dose IVMP, especially in resource-limited settings.
- Further multicenter trials with longer follow-up are recommended.
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