News & Views | Published:

THYROID DISEASE

Step-down steroid-sparing therapy in active thyroid eye disease

Nature Reviews Endocrinologyvolume 14pages634635 (2018) | Download Citation

Intravenous steroid therapy in thyroid eye disease has limitations and is potentially harmful at high doses. A steroid-sparing approach is a reasonable option, but combination therapy must be tested in randomized clinical trials designed to establish the efficacy and the potentially increased risk of adverse effects of combined immunosuppressive treatment.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1.

    Bartalena, L. et al. The 2016 European Thyroid Association/European Group on Graves’ orbitopathy — guidelines for the management of Graves’ orbitopathy. Eur. Thyroid J. 5, 9–26 (2016).

  2. 2.

    Bartalena, L. et al. Efficacy and safety of three different cumulative doses of intravenous methylprednisolone for moderate to severe and active Graves’ orbitopathy. J. Clin. Endocrinol. Metab. 97, 4454–4463 (2012).

  3. 3.

    Sipkova, Z. et al. Early use of steroid-sparing agents in the inactivation of moderate-to-severe active thyroid eye disease; a step-down approach. Clin. Endocrinol. https://doi.org/10.1111/cen.13834 (2018).

  4. 4.

    Perros, P., Crombie, A. L. & Kendall-Taylor, P. Natural history of thyroid associated ophthalmopathy. Clin. Endocrinol. 42, 45–50 (1995).

  5. 5.

    Goekoop-Ruiterman, Y. P. et al. Patient preferences for treatment: report from a randomised comparison of treatment strategies in early rheumatoid arthritis (BeSt trial). Ann. Rheum. Dis. 66, 1227–1232 (2007).

  6. 6.

    Kahaly, G. et al. Cyclosporin and prednisone v. prednisone in treatment of Graves’ ophthalmopathy: a controlled, randomized and prospective study. Eur. J. Clin. Invest. 16, 415–422 (1986).

  7. 7.

    Prummel, M. F. et al. Prednisone and cyclosporine in the treatment of severe Graves’ ophthalmopathy. N. Engl. J. Med. 321, 1353–1359 (1989).

  8. 8.

    Kahaly, G. J. et al. Mycophenolate plus methylprednisolone versus methylprednisolone alone in active, moderate-to-severe Graves’ orbitopathy (MINGO): a randomised, observer-masked, multicentre trial. Lancet Diabetes Endocrinol. 6, 287–298 (2018).

Download references

Acknowledgements

This work was in part supported by Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan Italy.

Author information

Affiliations

  1. Graves’ Orbitopathy Center, Endocrinology, Fondazione IRCCS Cà Granda, University of Milan, Milan, Italy

    • Mario Salvi

Authors

  1. Search for Mario Salvi in:

Competing interests

The author declares no competing interests.

Corresponding author

Correspondence to Mario Salvi.

About this article

Publication history

Published

DOI

https://doi.org/10.1038/s41574-018-0099-9

Newsletter Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing