Endocrine Research Center of Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, I.R. Iran .
Thyroid. 2017 Oct;27(10):1223-1231. doi: 10.1089/thy.2016.0652. Epub 2017 Sep 15.
Several studies have reported inconsistent findings on the advantages and disadvantages of long-term treatment with antithyroid drugs (ATD). A systematic review and meta-analysis was undertaken to clarify the numerous aspects of long-term treatment with ATD.
Medline and the Cochrane Library for trials published between 1950 and May 2016 were systematically searched. Studies containing data for long-term (>24 months) ATD treatment were included. Summary estimates of pooled prevalence, odds ratio, and weighted mean difference were calculated with a random effects model.
Of 587 related articles found, six fulfilled the inclusion criteria. Long-term ATD treatment induced a remission rate of 57% [confidence interval (CI) 45-68%], a rate that was higher in adults than in non-adults (61% vs. 53%). The rate of complications was 19.1% [CI 9.6-30.9%], of which only 1.5% were major complications. The annual remission rate for each year of treatment was 16% [CI 10-27%], which was higher in adults than non-adults (19% vs. 14%). However, it should be noted that this is not a true linear correlation, but a positive relationship can be suggested between time and remission rate. Meta-regression revealed that smoking had a significant lowering effect on remission rate.
Long-term ATD treatment is effective and safe, especially in adults, indicating that it should be considered as an alternative treatment for Graves' disease.
有几项研究报告了抗甲状腺药物（ATD）长期治疗的利弊存在不一致的结果。本系统评价和荟萃分析旨在阐明 ATD 长期治疗的诸多方面。
系统检索了 1950 年至 2016 年 5 月期间发表的 Medline 和 Cochrane 图书馆的试验。纳入包含 ATD 长期（>24 个月）治疗数据的研究。采用随机效应模型计算汇总估计的患病率、比值比和加权均数差。
在 587 篇相关文章中，有 6 篇符合纳入标准。长期 ATD 治疗诱导缓解率为 57%（置信区间 45-68%），成人高于非成人（61%比 53%）。并发症发生率为 19.1%（9.6-30.9%），其中仅 1.5%为严重并发症。每年的缓解率为治疗每增加一年的 16%（9-27%），成人高于非成人（19%比 14%）。然而，应该注意的是，这不是真正的线性相关性，而是可以提示时间与缓解率之间存在正相关关系。Meta 回归显示，吸烟对缓解率有显著的降低作用。
长期 ATD 治疗是有效且安全的，尤其是在成人中，这表明它应该被视为 Graves 病的一种替代治疗方法。
