Chen Jing, Xu Nuo, Sun Huilan, Chen Gang
Department of Ophthalmology, Fujian Provincial Hospital, Fuzhou, Fujian, China.
The Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China.
J Ophthalmol. 2021 Jul 12;2021:9799274. doi: 10.1155/2021/9799274. eCollection 2021.
The intravenous glucocorticoid (iv GC) represents the mainstay of therapy for Graves' ophthalmopathy (GO), but uncertainty remains concerning the optimal regimen. Although the European Group on Graves' Orbitopathy (EUGOGO) regimen has been commonly employed, evidence for its superiority to other regimens is still lacking. The aim of this meta-analysis was to compare the efficacy and safety of the EUGOGO regimen with higher-dose regimens in the management of GO.
A systematic review and meta-analysis of randomized controlled trials (RCTs) and cohort studies comparing the EUGOGO regimen with higher-dose regimens was conducted. PubMed, Embase, and Web of Science databases were searched for relevant studies. The efficacy outcomes were response rate, change in clinical activity score (CAS), rate of proptosis improvement, and retreatment rate. The safety outcome was the incidence of adverse events.
In the five included eligible trials, 136 participants in the EUGOGO regimen and 177 participants in higher-dose regimens were evaluated. Compared with the EUGOGO regimen, higher-dose regimens had no beneficial effect on the response rate, change of CAS, rate of proptosis improvement, and retreatment rate (OR: 1.3; 95% CI: 0.36-4.65; SMD: -0.04; 95% CI: -0.54, 0.45; OR: 0.79; 95% CI: 0.44-1.44; OR: 0.87; 95% CI: 0.27-2.77). For the incidence of adverse events, the results also showed no significant difference between the 2 groups (OR: 1.14; 95% CI: 0.62-2.09).
The current evidence showed that the efficacy of the EUGOGO regimen was comparable with higher-dose regimens. Since there was no significant difference in the incidence of adverse events between the two regimens, appropriate selection of patients and careful monitoring were required in both regimens. More well-designed, large-scale, and longer follow-up period studies were needed to further verify the finding of this analysis.
静脉注射糖皮质激素（iv GC）是格雷夫斯眼病（GO）治疗的主要手段，但关于最佳治疗方案仍存在不确定性。尽管欧洲格雷夫斯眼眶病研究组（EUGOGO）方案已被广泛应用，但其优于其他方案的证据仍然不足。本荟萃分析的目的是比较EUGOGO方案与高剂量方案在GO治疗中的疗效和安全性。
对比较EUGOGO方案与高剂量方案的随机对照试验（RCT）和队列研究进行系统综述和荟萃分析。检索PubMed、Embase和Web of Science数据库以查找相关研究。疗效指标为缓解率、临床活动评分（CAS）变化、突眼改善率和再治疗率。安全性指标为不良事件发生率。
在纳入的5项符合条件的试验中，对EUGOGO方案组的136名参与者和高剂量方案组的177名参与者进行了评估。与EUGOGO方案相比，高剂量方案在缓解率、CAS变化、突眼改善率和再治疗率方面没有有益影响（OR：1.3；95%CI：0.36 - 4.65；标准化均数差：-0.04；95%CI：-0.54，0.45；OR：0.79；95%CI：0.44 - 1.44；OR：0.87；95%CI：0.27 - 2.77）。对于不良事件发生率，两组结果也无显著差异（OR：1.14；95%CI：0.62 - 2.09）。
目前的证据表明，EUGOGO方案的疗效与高剂量方案相当。由于两种方案在不良事件发生率上无显著差异，两种方案均需要适当选择患者并仔细监测。需要更多设计良好、大规模且随访期更长的研究来进一步验证本分析的结果。
