Clinical efficacy of Glucocorticoids, Cyclophosphamide and Octreotide in the treatment of Graves' ophthalmopathy / 国际眼科杂志(Guoji Yanke Zazhi)

ABSTRACT

@#AIM: To explore the clinical effects of Glucocorticoids, Cyclophosphamide and Octreotide in the treatment of Graves' ophthalmopathy(GO). <p>METHODS: A retrospective study was conducted. Totally 102 patients(152 eyes)with GO admitted to the hospital between June 2018 and October 2019 were divided into glucocorticoid group(33 cases, 51 eyes), cyclophosphamide group(38 cases, 59 eyes), and octreotide group(31 cases, 42 eyes)according to the treatment method. All groups received 12wk of treatment. The treatment results were comparatively analyzed. Changes in proptosis degree, diplopia, intraocular pressure and visual acuity before and after treatment were measured. Clinical activity scoring(CAS)of thyroid associated eye movements was performed. Changes in ocular axes, eyeball transverse diameter, ocular apex distance, retrobulbar perimeter, area and volume were measured by eye ultrasound. Changes in thyrotropin receptor antibody(TRAb), thyroid peroxidase antibody(TPOAb)and thyroid volume before and after treatment were determined. The incidence of adverse reactions was counted. <p>RESULTS: Compared with octreotide group, grades of curative effect of glucocorticoid group and cyclophosphamide group were better(<i>P</i><0.05), but there was no statistically significant difference between glucocorticoid group and cyclophosphamide group(<i>P</i>>0.05). After 12wk of treatment, the proptosis degree and CAS scores of the three groups were decreased(<i>P</i><0.05), visual acuity and conscious diplopia were improved, ocular apex distance, retrobulbar perimeter, area and volume, TRAb, TPOAb and thyroid volume were decreased(<i>P</i><0.05). The proptosis degree, CAS scores, ocular apex distance, retrobulbar perimeter, area and volume, TRAb, TPOAb and thyroid volume of glucocorticoid group and cyclophosphamide group were smaller than those of octreotide group(<i>P</i><0.05), without statistically significant differences between glucocorticoid group and cyclophosphamide group(<i>P</i>>0.05). During treatment, the incidences of weight gain and the total incidence of adverse reactions were higher in glucocorticoid group than in cyclophosphamide group and octreotide group(<i>P</i><0.0167), but there were no statistically significant differences between cyclophosphamide group and octreotide group(<i>P</i>>0.0167). <p>CONCLUSION:Glucocorticoids and cyclophosphamide are better than octreotide in the treatment of GO, which can better improve ocular signs and thyroid-related lesions. Additionally, the incidence of adverse reactions caused by cyclophosphamide is lower than glucocorticoids, and its safety is higher. Therefore, cyclophosphamide is the first choice for treating GO.