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Elevated serum thyroid stimulating immunoglobulin linked to failure of first-line intravenous methylprednisolone monotherapy in moderate-to-severe thyroid eye disease

Eye volume 38, pages 687–690 (2024)Cite this article

Subjects

Abstract

Purpose

To assess factors associated with failure of intravenous methylprednisolone (IVMP) monotherapy as the first-line treatment for thyroid eye disease (TED) and to identify patients who might benefit from supplementing mycophenolate mofetil (MMF) to IVMP.

Methods

Data for all patients with TED treated with IVMP according to the EUGOGO protocol in our center between 2016–2021 were retrospectively analysed.

Results

Forty-seven patients (mean age 51.32 ± 14 years, 27 females) were enrolled. The mean time from first reported symptoms to first IVMP treatment was 12.1 ± 5.59 months (range 0–120). The mean clinical activity score (CAS) before treatment and at a mean of 5 and 12.2 weeks after treatment initiation was 6.00, 2.96, and 1.81, respectively (P < 0.01). Twenty-one patients (44.68%) were recommended second-line treatment: nine due to no response or worsening of CAS, six due to partial response, four with good response but early relapse after completion of treatment, and one due to late relapse. Eighteen of those 21 patients received second-line treatment which included rituximab (n = 7), MMF (n = 6), a second course of IVMP (n = 4), and tocilizumab (n = 1). Serum thyroid-stimulating immunoglobulin (TSI) levels were higher in patients who received second-line treatment compared with patients who responded well to first-line IVMP monotherapy at presentation (2135% vs 1159%, P = 0.05) and after completion of first-line treatment (2201% vs. 986%, P = 0.043).

Discussion

TED patients requiring second-line treatment after failed IVMP monotherapy had higher baseline and post-first-line treatment serum TSI levels. Those with elevated TSI may benefit from dual therapy (IVMP and MMF) and require closer monitoring.

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Authors and Affiliations

  1. The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Ofira Zloto, Arza Rosset, Ayelet Priel, Daphna Landau-Prat, Guy J. Ben Simon & Oded Sagiv

  2. Endocrinology Institute, Sheba Medical Center, Tel Hashomer, Israel, Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Tali Cukierman-Yaffe

  3. Clinical Immunology, Angioedema and Allergy Unit, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel, Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Ronen Shavit & Nancy Agmon-Levin

  4. Section of Ophthalmology, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Oded Sagiv

Authors
  1. Ofira Zloto
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  2. Arza Rosset
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Contributions

Conception/design of the research: OZ and OS. Data collection: AR. Analysis/interpretation: OZ and OS. Drafting the manuscript: OS. Revision of the manuscript: OZ, AR, AP, DLP, TCY, RS, NAL, and GJBS. Final approval of the manuscript: OZ, AR, AP, DLP, TCY, RS, NAL, GJBS, and OS.

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Correspondence to Oded Sagiv.

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Zloto, O., Rosset, A., Priel, A. et al. Elevated serum thyroid stimulating immunoglobulin linked to failure of first-line intravenous methylprednisolone monotherapy in moderate-to-severe thyroid eye disease. Eye 38, 687–690 (2024). https://doi.org/10.1038/s41433-023-02748-w

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