Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Rheumatology Department, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Clin Endocrinol (Oxf). 2018 Dec;89(6):834-839. doi: 10.1111/cen.13834. Epub 2018 Sep 11.
The current first-line treatment for management of active thyroid eye disease (TED) is high-dose intravenous corticosteroids, which have the potential for serious adverse effects. Our aim was to evaluate the effect of steroid-sparing agents (SSAs) in patients with moderate-to-severe active TED, using methotrexate as first-line.
Presented is a retrospective, four-year, single-centre, consecutive case series of patients with moderate-to-severe TED treated using the Oxford protocol. Treatment modality, disease activity, and adverse effects are reported at presentation, 6- and 12-month follow-up.
104 consecutive TED patients treated by the Oxford TED team were reviewed. 24 patients with moderate-to-severe active disease were identified (mean age 46.8 years;12 female) with a mean pretreatment VISA inflammatory index score of 5.5/10 (SD = 1.98; range 1-9). Intravenous methyl-prednisolone (IVMP) and an SSA was commenced in all patients. Mean total steroid dose was 2.72 g (SD = 1.4;1.0-6.9). 38% of patients (n = 9) received ≤1.5 g of IVMP. Only two patients required >4.5 g of IVMP equating to the EUGOGO treatment protocol dose for this patient group. There was significant improvement in inflammatory index score both at the intermediate review (mean score 2.7; SD = 2.8; P < 0.001; mean follow up 25.2 weeks) and at one year or last follow-up (mean score 1.4; SD = 1.5; P < 0.001; mean follow up 48.0 weeks). No serious or long-term adverse effects were reported.
This study suggests that the initiation of an SSA, using methotrexate as first-line, with limited adjuvant IVMP is an effective and safe treatment for moderate-to-severely active TED, resulting in a significant reduction in both disease activity and total steroid load.
目前，治疗活动期甲状腺眼病（TED）的一线治疗方法是大剂量静脉注射皮质类固醇，但其具有发生严重不良反应的潜在风险。我们的目的是评估在中重度活动期 TED 患者中使用甲氨蝶呤作为一线药物的情况下，类固醇保存剂（SSA）的治疗效果。
本研究为回顾性、四年、单中心、连续病例系列研究，纳入了使用牛津方案治疗的中重度 TED 患者。在就诊时、6 个月和 12 个月随访时报告了治疗方式、疾病活动度和不良反应。
共回顾了 104 例由牛津 TED 团队治疗的 TED 患者。其中 24 例患者患有中重度活动性疾病（平均年龄 46.8 岁，女性 12 例），治疗前 VISA 炎症指数评分为 5.5/10（SD=1.98；范围 1-9）。所有患者均开始静脉注射甲泼尼龙（IVMP）和 SSA。平均总类固醇剂量为 2.72g（SD=1.4；1.0-6.9）。38%（n=9）的患者接受的 IVMP 剂量≤1.5g。只有两名患者需要>4.5g 的 IVMP，相当于该患者组的 EUGOGO 治疗方案剂量。在中期评估时（平均评分 2.7，SD=2.8，P<0.001；平均随访 25.2 周）和一年或最后一次随访时（平均评分 1.4，SD=1.5，P<0.001；平均随访 48.0 周），炎症指数评分均有显著改善。未报告严重或长期不良反应。
本研究表明，使用甲氨蝶呤作为一线药物，辅以有限剂量的 IVMP，启动 SSA 治疗中重度活动期 TED 是一种有效且安全的治疗方法，可显著降低疾病活动度和总类固醇负荷。
