Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy.
Front Endocrinol (Lausanne). 2020 Dec 22;11:609895. doi: 10.3389/fendo.2020.609895. eCollection 2020.
High dose intravenous glucocorticoid (ivGC) therapy is the first line treatment in moderate to severe Graves' ophthalmopathy (GO) and is associated with a clinical response rate ranging from 50% to 80%. Recently, a positive correlation between total cholesterol and low-density lipoproteins cholesterol (LDLc) with GO presentation and activity has been described.
We aimed at evaluating whether, in patients with moderate to severe active GO treated with ivGC therapy, cholesterol, and LDLc could represent valuable predictive factors of medium-term GO outcome.
This single center retrospective study was conducted in a consecutive series of 87 patients undergone ivGC therapy because affected by moderate to severe active GO. Clinical outcome of GO was evaluated at week 6 (W6) and 12 (W12) in respect to baseline conditions (week 0) by the seven points CAS according to EUGOGO recommendations. Univariate analysis and binary logistic regression were performed for the outcome variable W12CAS.
In patients with active GO, an early positive clinical response to ivGC therapy (as evaluated by CAS at 6W) was a strong determinant (OR=13) of the clinical outcome at week 12. Moreover, high levels of LDLc at baseline were positively associated with a reduction in the likelihood of being classified as improved at 12W. Patients with LDLc >193.6 mg/dl were very likely to respond negatively to ivGC therapy independently from the response at 6W. Based on these results, we propose a predictive decision-making model to be tested in future prospective studies.
We found that, in patients with active GO, both an early clinical response to ivGC therapy and baseline LDLc levels are significant determinants of GO outcome (W12CAS). These data support the need of a cholesterol-lowering treatment before addressing these patients to ivGC therapy.
大剂量静脉内糖皮质激素（ivGC）治疗是中重度格雷夫斯眼病（GO）的一线治疗方法，其临床反应率在 50%至 80%之间。最近，有人描述了总胆固醇和低密度脂蛋白胆固醇（LDLc）与 GO 表现和活动之间存在正相关关系。
我们旨在评估中重度活动性 GO 患者接受 ivGC 治疗后，胆固醇和 LDLc 是否可以作为中期 GO 结局的有价值的预测因素。
这是一项单中心回顾性研究，纳入了 87 例因中重度活动性 GO 而接受 ivGC 治疗的连续患者系列。根据 EUGOGO 建议的七点 CAS，在基线（第 0 周）、第 6 周（W6）和第 12 周（W12）评估 GO 的临床结局。对 W12CAS 这个结局变量进行单变量分析和二项逻辑回归分析。
在活动性 GO 患者中，ivGC 治疗 6 周时的早期临床反应（通过 CAS 评估）是 12 周时临床结局的一个强有力的决定因素（OR=13）。此外，基线时 LDLc 水平较高与 12 周时改善的可能性降低呈正相关。无论 6 周时的反应如何，LDLc>193.6mg/dl 的患者对 ivGC 治疗极有可能产生负面反应。基于这些结果，我们提出了一个预测决策模型，有待未来的前瞻性研究进行验证。
我们发现，在活动性 GO 患者中，ivGC 治疗的早期临床反应和基线 LDLc 水平是 GO 结局（W12CAS）的重要决定因素。这些数据支持在为这些患者进行 ivGC 治疗之前，需要进行降脂治疗。
