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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, P. Rajendram, R. Hanna, S. Wilson, V. Pell, J. Li, C. Cook, A. Gattamaneni, Rao Plowman, N. Jackson, S.
Taylor, P.
Rajendram, R.
Hanna, S.
Wilson, V.
Pell, J.
Li, C.
Cook, A.
Gattamaneni, Rao
Plowman, N.
Jackson, S.
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Abstract
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: 3 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 randomised 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, modified EUGOGO score or Ophthalmopathy Index.Clinical Activity Score (CAS), Ophthalmopathy Index and Total Eye Score improved over 3 years (p<0.001). However, quality of life at 3 years remained poor. Of 64 individuals with available surgical outcome data, 24/64 (37.5%) required surgical intervention. Disease duration of greater than 6 months before treatment was associated with increased need for surgery OR=16.8 (95%CI 2.95, 95.0) p=0.001. 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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Date
2023
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Article
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Taylor P, Rajendram R, Hanna S, Wilson V, Pell J, Li C, et al. Factors predicting long-term outcome and the need for surgery in Graves Orbitopathy: extended follow-up from the CIRTED Trial. The Journal of clinical endocrinology and metabolism. 2023 Mar 27. PubMed PMID: 36971324. Epub 2023/03/28. eng.