Weekly or Monthly Glucocorticoid Regimens effective for Treatment of Graves' Orbitopathy

Based on limited data, weekly or monthly regimens should be preferred for treating individuals with moderately severe Graves' orbitopathy (GO), says an article published in Frontiers in Pharmacology.

Intravenous glucocorticoid (GC) therapy has been suggested to treat moderately severe Graves' orbitopathy; however, the best regimen is still being debated. As a result, Jun Jia and colleagues conducted this network meta-analysis to objectively establish the comparative effectiveness and safety of several intravenous GC regimens for the treatment of GO, including daily, weekly, and monthly intravenous regimes.

From the inception of each database to March 2021, researchers searched Medline (via PubMed), EMBASE (via OVID), and the Cochrane Central Register of Controlled Trials (CENTRAL) (via OVID) for randomized controlled trials (RCTs) investigating the comparative efficacy and safety of different intravenous GC regimes in GO patients. The most recent search was conducted in June 2021. The original studies' risk of bias was assessed using the Cochrane risk of bias assessment technique. The Markov chain Monte Carlo (MCMC) simulation was used to do a random-effects Bayesian network meta-analysis. To rate all regimes, the ranking probabilities of all regimes were determined. The ADDIS program was used for statistical analysis.

The key findings of this study were as follow:

1. The criteria were satisfied by ten research including 593 patients.

2. According to a network meta-analysis, the weekly intravenous GC regime (WR) and monthly intravenous regime (MR) outperformed the oral GC (OGC) regime in terms of response and CASC.

3. Meanwhile, pooled data revealed that the WR was associated with a lower risk of AEs when compared to the OGC regime and daily intravenous GC regime (DR).

4. According to the ranking probabilities, the MR and WR have a relatively larger possibility of being the best choices for response, proptosis, and AEs.

In conclusion, because the WR or MR is substantially associated with better response, reduced CAS, and lower AEs than the OGC regime, it should be preferred for the treatment of moderate-to-severe GO. More research with a larger sample size, however, is needed to corroborate our findings and compare the WR to the MR. Furthermore, experts recommend doing additional studies that directly evaluate the comparative effects of the MR and DR, as no direct comparison has been reported so far.

Reference:

Jia, J., Dong, J., & Deng, L. (2022). Network Meta-Analysis of Different Intravenous Glucocorticoid Regimes for the Treatment of Graves' Orbitopathy. In Frontiers in Pharmacology (Vol. 13). Frontiers Media SA. https://doi.org/10.3389/fphar.2022.785757