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Factors Predicting Long-term Outcome and the Need for Surgery in Graves Orbitopathy: Extended Follow-up From the CIRTED Trial.
Taylor, Peter; Rajendram, Rathie; Hanna, Stephanie; Wilson, Victoria; Pell, Julie; Li, Chunhei; Cook, Anne; Gattamaneni, Rao; Plowman, Nicholas; Jackson, Sue; Hills, Robert; French, Robert; Uddin, Jimmy M; Lee, Richard W J; Dayan, Colin M.
Afiliación
  • Taylor P; Thyroid Research Group, Cardiff University School of Medicine, Cardiff CF14 4XN, UK.
  • Rajendram R; Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK.
  • Hanna S; Thyroid Research Group, Cardiff University School of Medicine, Cardiff CF14 4XN, UK.
  • Wilson V; Bristol Medical School, University of Bristol, UK.
  • Pell J; Thyroid Research Group, Cardiff University School of Medicine, Cardiff CF14 4XN, UK.
  • Li C; Thyroid Research Group, Cardiff University School of Medicine, Cardiff CF14 4XN, UK.
  • Cook A; Manchester Royal Eye Hospital, Manchester, M13 9WH, UK.
  • Gattamaneni R; Christie Hospital, Manchester, M20 4BX, UK.
  • Plowman N; Bristol Haematology and Oncology Centre, Bristol, BS2 8ED, UK.
  • Jackson S; Centre for Appearance Research, University of the West of England, Bristol, BS16 2JP, UK.
  • Hills R; Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK.
  • French R; Thyroid Research Group, Cardiff University School of Medicine, Cardiff CF14 4XN, UK.
  • Uddin JM; Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK.
  • Lee RWJ; Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK.
  • Dayan CM; Bristol Medical School, University of Bristol, UK.
J Clin Endocrinol Metab ; 108(10): 2615-2625, 2023 09 18.
Article en En | MEDLINE | ID: mdl-36971324
Graves orbitopathy is both disabling and disfiguring. Medical therapies to reduce inflammation are widely used, but there is limited trial data beyond 18 months of follow-up. METHODS: Three-year follow-up of a subset of the CIRTED trial (N = 68), which randomized patients to receive high-dose oral steroid with azathioprine/placebo and radiotherapy/sham radiotherapy. RESULTS: Data were available at 3 years from 68 of 126 randomized subjects (54%). No additional benefit was seen at 3 years for patients randomized to azathioprine or radiotherapy with regard to a binary clinical composite outcome measure (BCCOM), modified European Group on Graves' Orbitopathy score, or Ophthalmopathy Index.Clinical Activity Score (CAS), Ophthalmopathy Index, and Total Eye Score improved over 3 years (P < .001). However, quality of life at 3 years remained poor. Of 64 individuals with available surgical outcome data, 24 of 64 (37.5%) required surgical intervention. Disease duration of greater than 6 months before treatment was associated with increased need for surgery [odds ratio (OR) 16.8; 95% CI 2.95, 95.0; P = .001]. Higher baseline levels of CAS, Ophthalmopathy Index, and Total Eye Score but not early improvement in CAS were associated with increased requirement for surgery. CONCLUSION: In this long-term follow-up from a clinical trial, 3-year outcomes remained suboptimal with ongoing poor quality of life and high numbers requiring surgery. Importantly, reduction in CAS in the first year, a commonly used surrogate outcome measure, was not associated with improved long-term outcomes.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Oftalmopatía de Graves Tipo de estudio: Clinical_trials / Observational_studies / Prognostic_studies / Risk_factors_studies Aspecto: Patient_preference Límite: Humans Idioma: En Revista: J Clin Endocrinol Metab Año: 2023 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Oftalmopatía de Graves Tipo de estudio: Clinical_trials / Observational_studies / Prognostic_studies / Risk_factors_studies Aspecto: Patient_preference Límite: Humans Idioma: En Revista: J Clin Endocrinol Metab Año: 2023 Tipo del documento: Article Pais de publicación: Estados Unidos