Effectiveness of Different Treatment Modalities in Initial and Chronic Phases of Thyroid Eye Disease: A Systematic Review With Meta-analysis.

Autor:	Alves Junior JM; Postgraduate Course Internal Medicine, Campinas State University, Campinas 13083-888, SP, Brazil., Bernardo W; Department of Evidence-Based Medicine, University of São Paulo, São Paulo 01246-903, SP, Brazil., Villagelin D; Postgraduate Course Internal Medicine, Campinas State University, Campinas 13083-888, SP, Brazil.; Medical School, Pontifical Catholic University of Campinas, Campinas 13034-685, SP, Brazil.
Jazyk:	angličtina
Zdroj:	The Journal of clinical endocrinology and metabolism [J Clin Endocrinol Metab] 2024 Oct 15; Vol. 109 (11), pp. 2997-3009.
DOI:	10.1210/clinem/dgae526
Abstrakt:	Background: Thyroid eye disease (TED), a common extrathyroidal manifestation of Graves disease, poses significant management challenges due to potential disfigurement, visual impairment, and decreased quality of life. Uncertainties remain about the optimal treatment approach, especially regarding TED duration and its impact on outcomes. Objective: This meta-analysis evaluates the effects of various treatments on inflammatory markers and severity endpoints in TED, stratified by disease duration, distinguishing between treatments initiated within the first 6 months (initial phase) and those initiated thereafter (subacute/chronic phase). Methods: Following PRISMA guidelines, a systematic search of multiple electronic databases yielded 26 studies meeting predefined inclusion criteria. Methodological quality was assessed, and data were meticulously extracted and analyzed. Results: In the initial phase, treatments like corticosteroids and teprotumumab showed significant improvements in clinical activity score, proptosis, and diplopia. In the subacute/chronic phase, the efficacy of methylprednisolone and teprotumumab is reduced. A "critical window" effect was observed, with treatments showing diminished efficacy after 6 months of TED duration. Conclusion: This meta-analysis highlights the importance of tailoring treatment strategies based on TED duration, emphasizing early interventions to maximize benefits. The findings guide clinicians in selecting optimal treatments and underscore the need for further research to refine evidence-based approaches, ultimately enhancing patient outcomes and quality of life. (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. See the journal About page for additional terms.)
Databáze:	MEDLINE
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