Randomised double-blind trial of prednisone versus radiotherapy in Graves' ophthalmopathy

doi:10.1016/0140-6736(93)92001-A

The Lancet

Volume 342, Issue 8877, 16 October 1993, Pages 949-954

https://doi.org/10.1016/0140-6736(93)92001-A Get rights and content

Abstract

Summary

Corticosteroids are usually given for management of Graves' ophthalmopathy, but they have many and serious side-effects. By comparison, retrobulbar irradiation is well tolerated, although its efficacy has been evaluated only in uncontrolled studies. Therefore, we did a double-blind randomised trial, in which 28 patients with moderately severe Graves' ophthalmopathy were treated with a 3-month course of oral prednisone and sham irradiation, and 28 received retrobulbar irradiation (20 Gy) and placebo capsules. Therapeutic outcome, assessed twenty-four weeks after the start of treatment, was determined by the change in the highest NOSPECS class.

A successful outcome was observed in 14 prednisone-treated and in 13 irradiated patients. Responders to treatment (but not nonresponders) in both groups showed improvements in total and subjective eye score and a decrease in eye-muscle volume. Response to either treatment was due largely to changes in soft-tissue involvement and eye-muscle motility. Mean elevation in responders to radiotherapy increased from 18·5° (95% Cl 14 8-22·2) at baseline to 21·8° (18·6-25·0) at week twenty-four (p=0·003), but did not change in prednisone responders. Side-effects were more frequent and severe during prednisone than during radiotherapy.

Radiotherapy and oral prednisone appear to be equally effective as initial treatment in patients with moderately severe Grave's ophtalmopathy. In view of its better tolerability radiotherapy should be considered the treatment of first choice. Lancet 1993; 342: 949–54

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ArticlesRandomised double-blind trial of prednisone versus radiotherapy in Graves' ophthalmopathy

Abstract

Lancet

Surv Ophthalmol

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Am J Ophthalmol

Int J Radiat Oncol Biol Phys

Endocrinol Metab Clin North Am

Methods Enzymol

Endocrine ophthalmopathy: current ideas concerning etiology, pathogenesis, and treatment

Endocr Rev

Supervoltage orbital radiotherapy for Graves' ophthalmopathy

J Clin Endocrinol Metab

Orbital cobalt irradiation combined with systemic corticosteroids for Graves' ophthalmopathy: comparison with systemic corticosteroids alone

J Clin Endocrinol Metab

Therapeutic outcome of prednisone medication and of orbital irradiation in patients with Graves' ophthalmopathy

Ophthalmologica

Prednisone and cyclosporine in the treatment of severe Graves' ophthalmopathy

N Engl J Med

An evaluation of supervoltage orbital irradiation for Graves' ophthalmopathy

Clin Endocrinol

Articles
Randomised double-blind trial of prednisone versus radiotherapy in Graves' ophthalmopathy