Common Immunosuppressive Monotherapy for Graves’ Ophthalmopathy: A Meta-Analysis
| Autor: | Qiu-hong Wang, Rui-Li Wei, Yun Zhang, Yu-Zhen Li, Pei Mou, Jin-Wei Cheng, Cheng-cheng Zeng, Lihong Jiang, Heng Lou |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2015 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Science MEDLINE law.invention Graves' ophthalmopathy Randomized controlled trial law Internal medicine medicine Humans Adverse effect Clinical Trials as Topic Multidisciplinary business.industry Orbital radiotherapy medicine.disease eye diseases Radiation therapy Graves Ophthalmopathy Treatment Outcome Tolerability Meta-analysis Medicine Safety business hormones hormone substitutes and hormone antagonists Immunosuppressive Agents Research Article |
| Zdroj: | PLoS ONE PLoS ONE, Vol 10, Iss 10, p e0139544 (2015) |
| ISSN: | 1932-6203 |
| Popis: | BackgroundSeveral immunosuppressive therapeutic regimens are widely used to treat Graves' ophthalmopathy (GO), including oral glucocorticoids (OGC), intravenous glucocorticoids (IVGC), retrobulbar injections of glucocorticoids (ROGC) and orbital radiotherapy (OR). The priority among these is unknown. This meta-analysis investigated the efficacy and tolerability of the above regimens.MethodsThe PubMed, EMBASE, and Cochrane Library databases and the Chinese Biomedicine Database were searched up to November 18, 2014. Randomized controlled trials (RCTs) comparing monotherapies (OGC, IVGC, ROGC and OR) in patients with moderate-to-severe active GO were selected. The main efficacy measures were the response rate, the standard mean difference (SMD) in the reduction in the clinical activity score (CAS) and the mean difference (MD) in proptosis from baseline to the end of treatment. The main tolerability measure was the risk ratio (RR) for adverse events. The pooled estimates and 95% confidence intervals (95% CIs) were calculated using the RevMan software, version 5.1.ResultsSeven published RCTs involving 328 participants were included in the present meta-analysis, including IVGC versus OGC (3 trials), ROGC versus OGC (3 trials) and OR versus OGC (1 trial). IVGC was more effective than OGC in response rate (RR = 1.48, 95% CI = 1.18-1.87) and had an obvious CAS reduction (SMD = 0.69, 95% CI = 0.13-1.25). IVGC caused fewer adverse events than OGC. ROGC and OGC had no statistically significant difference in response rate (RR = 1.16, 95% CI = 0.94-1.42). OR also did not differ significantly compared with OGC (RR = 0.93, 95% CI = 0.54-1.60). ROGC and OR had fewer adverse events, such as weight gain, compared with OGC.ConclusionsFor patients with GO in the moderate-to-severe active phase, current evidence gave priority to IVGC, which had a statistically significant advantage over OGC and caused fewer adverse events. ROGC and OR did not provide greater efficacy than OGC, although better tolerability and fewer adverse events were shown. |
| Databáze: | OpenAIRE |
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