Abstract
Graves' ophthalmopathy (GO) is a specific immune-mediated disorder, whose treatment
is sometimes difficult. In order to investigate the efficacy of intravenous methylprednisolone
(MP) pulse therapy in GO, we studied eight patients with GO, followed up for at least
6 months by clinical patient self-assessment, ophthalmological examination and orbital
computed tomography (OCT). A 12.5 mg/kg dose of MP was administered intravenously
over a 10 hour period, once every month. Three to six MP pulse administrations were
performed in each patient. All patients were outpatients. A 0.5 mg/kg/day oral pred-nisone
dose was given to each patient as interpulse therapy. Clinical assessment of MP pulse
therapy showed a good response in 87.5% and no response in 12.5% of patients. The
treatment was rapidly efficient, mostly on patient self-assessment, soft tissue inflammation,
ophthalmoplegia, corneal involvement, visual acuity and extraocular muscle enlargement
on OCT. Post-treatment ophthalmic index was significantly improved (6.75 ± 3.06 vs.
2.5 ± 1.41: p<0.05). MP pulse therapy had less effect on proptosis (22.94 ± 2.32thinsp;mm
vs. 21.56 ± 2.22mm: p<0.05). No adverse effects were noted with MP pulse therapy.
Patients showed no relapse of eye involvement during a mean follow up of 31.8 months
(2-77 months). In conclusion, our results suggest that intravenous MP pulse therapy
is a good immunosuppressive therapy for GO. Moreover, in comparison with the previous
studies, the MP dose used in our present study appears to be optimal with high efficacy.
MP pulse therapy represents a safe and efficient treatment in GO, which can easily
be performed in outpatients.
Key words
Graves' disease - Graves' ophthalmopathy - Methylprednisolone - Pulse therapy
