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Intravenous glucocorticoid therapy is superior to oral glucocorticoid therapy in patients with Graves’ eye disease

The background of the study. Graves’ eye disease is characterized by inflammation of eye muscles and fibroadipose tissue around the eyes, and affected patients are often treated with oral or intravenous glucocorticoids because of their potent antinflammatory and immunosuppressive activity. In this study, the efficacy of oral and intravenous glucocorticoid therapy was compared in patients with Graves’ eye disease.

How the study was done. The study subjects were 70 patients with active Graves’ eye disease of recent onset. All had marked soft-tissue swelling, double vision, or eye protrusion (exophthalmos) or optic neuropathy (swelling or pallor of the optic disk, visual-field defects, or decreased visual acuity). Most had hyperthyroidism and were being treated with an antithyroid drug.

The patients were randomly assigned to receive 500 mg of methylprednisolone intravenously (IV) once weekly for 6 weeks and then 250 mg weekly for 6 weeks (total, 4.5 g) or 100 mg of prednisolone orally daily for 1 week, after which the dose was reduced by 10 mg daily at weekly intervals, and stopped after 12 weeks (total, 4 g). The patients underwent complete ophthalmic examinations at base line and 12 weeks.

The results of the study. The base-line characteristics and ophthalmologic findings in the 35 patients in each group were similar. Among the patients in the IV methylprednisolone group, 60 percent had a ≥2 mm decrease in exophthalmos, 63 percent had a ≥2 mm decrease in eyelid width, and 27 had a definite decrease in inflammation; the respective numbers in the oral prednisolone group were 40 percent, 40 percent, and 51 percent. Ophthalmopathy worsened in 6 percent of the patients treated with IV methylprednisolone and 14 percent of those treated with oral prednisolone. Smokers in either group were more likely to have worsening of ophthalmopathy during treatment.

The conclusions of the study. Treatment with IV methylprednisolone is superior to oral prednisolone in ameliorating ophthalmic symptoms and improving vision in patients with Graves’ eye disease.

The original article. Kahaly GJ, Pitz S, Hommel G, Dittmar M. Randomized, single blind trial of intravenous versus oral steroid monotherapy in Graves’ orbitopathy. J Clin Endocrinol Metab 2005;90:5234-40.