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Therapeutic efficacy predictors of methylprednisolone in thyroid-associated ophthalmopathy

10 Oct 2018

The efficacy of intravenous methylprednisolone (IVMP) for treating moderate-to-severe active thyroid-associated ophthalmopathy (TAO) may be predicted by factors such as levels of thyroid stimulating hormone (TSH), anti-TSH-receptor antibodies (TRABs) and triglycerides, as well as eye symptom duration, a study reports.

Researchers looked at 302 consecutive patients with moderate-to-severe and active TAO who underwent the full IVMP therapy course. They identified independent predictors of treatment efficacy in the training set (n=200) and validated the prediction model in the validation set (n=102).

Multivariable logistic regression analysis revealed therapeutic efficacy to be associated with pretreatment clinical activity score (odds ratio [OR], 3.506; p<0.001), elevated TSH levels during treatment (OR, 0.145; p=0.005), pretreatment anti-TRAB levels (OR, 0.061; p<0.001), duration of eye symptoms (OR, 0.878; p=0.017) and pretreatment triglyceride levels (OR, 0.090; p=0.001).

The multivariable prediction model demonstrated good calibration and excellent discrimination, with an area under curve of 0.915 in the training set (p<0.001) and 0.885 (p<0.001) in the validation set.

Overall, the present data indicate that low pretreatment clinical activity score, positive pretreatment TRAB levels, prolonged duration of eye symptoms, elevated TSH levels during treatment, and high pretreatment triglyceride levels may negatively affect IVMP efficacy for moderate-to-severe TAO, according to researchers.

Additionally, the prediction model may help clinicians determine the indication and prognosis of IVMP therapy. In the management of TAO patients, researchers suggested early diagnosis and treatment (within 15 months), prompt restoration and maintenance of euthyroidism (meticulous control of TSH levels, ≤5 μIU/mL) and regular monitoring of triglyceride levels.

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