Combined glucocorticoids and cyclophosphamide in the treatment of Graves' ophthalmopathy: a systematic review and meta-analysis

• Published in: BMC endocrine disorders Vol. 24; no. 1; p. 12
• Main Authors: Xiang, Qilang, Yang, Mengling, Luo, Wenxuan, Cao, Yuzi, Shuai, Shiquan, Wei, Xin, Xiong, Anji
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 26.01.2024; BioMed Central; BMC
• Subjects: Analysis; Autoimmune diseases; B cells; Bias; Body fat; China; Clinical trials; Corticosteroids; Cyclophosphamide; Cyclophosphamide - therapeutic use; Cytokines; Data analysis; Evidence-based medicine; Fibroblasts; Glucocorticoids; Glucocorticoids - therapeutic use; Graves ophthalmopathy; Graves Ophthalmopathy - drug therapy; Humans; Insulin-like growth factors; Medical colleges; Medical research; Meta-analysis; Monoclonal antibodies; Pathogenesis; Response rates; Statistical analysis; Systematic review; China; Systematic review; Cyclophosphamide; Glucocorticoids; Graves ophthalmopathy; Meta-analysis
• ISSN: 1472-6823; 1472-6823
• DOI: 10.1186/s12902-024-01545-0

To evaluate the efficacy and safety of combined glucocorticoids (GCs) and cyclophosphamide (CYC) treatment in Graves' ophthalmopathy (GO). We searched PubMed, Embase, Cochrane Library, and four Chinese databases (Chinese National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), WanFang, and SinoMed) for any published randomized controlled trials (RCTs) produced from inception to December 1, 2023. Articles obtained using appropriate keywords were selected independently by two reviewers according to the established inclusion and exclusion criteria. We retrieved 1120 records which were eventually reduced to 13 RCTs which were then included in this evaluation. Pooled results indicated that the experimental group (CYC/GCs) showed a higher response rate than control group (GCs or negative control) (RR 1.27; 95% confidence interval 1.19 to 1.37). The subgroup analysis showed that the difference in response rates among treatment protocols (CYC/P, CYC/MPS, CYC/DEX) was not statistically significant (p = 0.23). The combination of GCs and CYC could be recommended as a therapeutic option for GO, especially in patients who experience recurrence after a withdrawal GCs, have a poor response to GCs, or cannot obtain monoclonal antibody agents for various reasons.