CLINICAL OUTCOMES OF INTRAVENOUS GLUCOCORTICOID THERAPY WITH OR WITHOUT ORBITAL RADIOTHERAPY OR MYCOPHENOLATE MOFETIL...

Area of Science:

• Ophthalmology
• Endocrinology
• Immunology

Background:

• Graves' orbitopathy (GO) is an autoimmune inflammatory condition causing proptosis, diplopia, and restricted eye movements.
• Intravenous glucocorticoids (IVGC) are a primary treatment for active moderate-to-severe GO.
• Some patients with GO require additional therapies beyond IVGC.

Purpose of the Study:

• To compare clinical outcomes of IVGC monotherapy versus combination therapy with orbital radiotherapy (RT) or mycophenolate mofetil (MMF) in active moderate-to-severe GO.
• To evaluate the efficacy of different treatment strategies for reducing GO disease activity and symptoms.

Main Methods:

• A retrospective study included 40 patients with active moderate-to-severe GO (Clinical Activity Score ≥3).
• Patients were grouped into IVGC monotherapy (n=24), IVGC+RT (n=8), and IVGC+MMF (n=8).
• Outcomes assessed included Clinical Activity Score (CAS), proptosis, diplopia, and motility at baseline and 6 months.

Main Results:

• CAS significantly decreased in all treatment groups (p<0.001).
• All combination therapy groups achieved a ≥2-point CAS reduction, compared to 91.7% in the IVGC-only group.
• Proptosis reduction was observed in 57.1% (IVGC), 100% (IVGC+RT), and 71.4% (IVGC+MMF); however, differences were not statistically significant (p=0.534).
• No significant differences were found in diplopia or motility outcomes between groups.

Conclusions:

• IVGC is effective in reducing disease activity in active moderate-to-severe GO.
• Combination therapies (IVGC+RT, IVGC+MMF) showed numerically favorable trends but did not reach statistical significance.
• Limited sample size and unequal group distribution necessitate caution; larger prospective studies are required to determine the comparative efficacy of these treatment strategies.