Meta-analysis Of The Efficacy And Safety Of Mycophenolate Mofetil For The Treatment Of Graves' Orbitopathy

Background:Graves'orbitopathy(GO)is an organ-specific autoimmune thyroid disease,which is the first incidence of eyelid disease in adults.Although the exact mechanism of GO is still unclear,but the pathological role of T lymphocytes and B lymphocytes have been clearly confirmed.A variety of immunosuppressive therapies have been used to reduce the stage of autoimmune inflammation and control the progression of GO,but the best treatment strategy has not yet reached a consensus,we have been committed to the development of new treatments.Mycophenolate mofetil has attracted attention for its specific action on lymphocytes and the safety of heart,liver and kidney.However,previous studies have small sample sizes and lack of strong persuasive shortcomings.This study intends to investigate all previously published randomized controlled trials of mycophenolate mofetil in the treatment of GO to evaluate its efficacy and safety,and hope to provide further evidence for clinical treatment.Objectivet:To explore the efficacy and safety of mycophenolate mofetil for the treatment of graves'orbitopathy,we conduct this Meta-analysis.Methods:Articles about mycophenolate mofetil and graves'ophthalmopathy published from the establishment of the database to February 2019 were searched.The domestic and foreign databases were searched in computer,including:the Cochrane Library,PubMed,CNKl,Weipu net,Wanfang database and so on.According to the methodological evaluation of the study,the quality of the literature was included and the effective data were extracted.the evaluation indicators included the main outcome indicators,such as the overall effective rate of treatment,and secondary outcome indicators,such as side effects.Meta analysis was performed by using RevMan 5.3software.Stata13.0 software was used for biased analysis.Results:In this meta-analysis,a total of 5 studies were included:1 English study and 4Chinese studies.The overall efficacy of mycophenolate mofetil and glucocorticoids in the treatment of graves'orbitopathy,was compared,including 363 patients with thyroid-associated ophthalmopathy,including 189 in the mycophenolate group and174 in the glucocorticoid group.The results reported in the five literatures were combined.The heterogeneity results indicated that there was no heterogeneity between the studies(I~2=41%),so the fixed effect model was used for the analysis.Mycophenolate mofetil is superior to glucocorticoids in the treatment of graves'orbitopathy(OR=4.52,95%CI(2.53-8.09),P<0.00001).Due to the limitations of the data included in the study,only the incidence of total adverse reactions was selected as a safety indicator.Five articles in this meta-analysis reported the total number of adverse reactions of mycophenolate mofetil and glucocorticoids in the treatment of thyroid-associated ophthalmopathy,including 363 patients with thyroid-related diseases,including 189 patients in the mycophenolate mofetil group,and 174 patients in the glucocorticoid group The results of the five literatures were analyzed by meta-analysis.The heterogeneity test results showed that there was no heterogeneity between the studies(I~2=0%),so the fixed effect model was used for the combined analysis.The results showed that the total adverse reaction rate of mycophenolate mofetil was lower in the treatment of thyroid-associated ophthalmopathy than in the glucocorticoid group(OR=0.12,95%CI(0.06-0.25),P<0.00001).Conclusions:Mycophenolate mofetil is a curative and safe treatment for Graves'obitopathy,and it is necessary to conduct more large-sample high-quality RCT for further evaluation.