Meta-analysis Of The Efficacy And Safety Of Methylprednisolone For The Treatment Of Thyroid-associated Ophthalmopathy

Background:Thyroid-associated ophthalmopathy(TAO),also known as Graves eye disease,is a common autoimmune inflammatory disease involving adult orbital tissues and extraocular muscles in adults.Its pathogenesis is more complex,and it has not been fully studied.At present,the pathogenesis is generally recognized that T,B lymphocytes,periorbital fibroblasts and a variety of inflammatory cytokines participate in the occurrence and development of the disease.The main clinical manifestations are exophthalmos,periorbital and conjunctival edema,diplopia,and severe cases can progress to corneal ulcers and even blindness.At present,the main treatment methods are drug therapy,periorbital irradiation and surgery.Most patients with mild TAO can be relieved after general treatment.However,for moderate-to-severe,active TAO,hormone therapy is the main treatment method,mainly oral and intravenous impact injection and three treatment methods.The efficacy and safety of the three modes of administration need to be further studied.At present,a number of clinical studies have concluded that compared with other drugs and administration methods,hormone intravenous shock therapy is more accurate and safer for moderate to severe TAO.Therefore,in this study,a systematic search of all currently published randomized controlled clinical trials(RCT)of methylprednisolone venous impulse for thyroid-associated ophthalmopathy was performed,and a meta-analysis was performed to systematically review the methylprednisolone intravenous impulse for thyroid The efficacy and safety of related eye diseases,in order to provide more evidence for the clinical treatment of TAO.Objective:Meta-analysis was used to evaluate the efficacy and safety of methylprednisolone intravenous shock in the treatment of thyroid-associated ophthalmopathy.Methods:Systematic search of Chinese databases such as PubMed,The Cochrane Library,Embase,Web of Science,CNKI,Wanfang Database,China Biomedical Literature Database(CBM),Weipu,etc.All databases have been published until October 30,2019.Randomized controlled trial of methylprednisolone intravenous shock in the treatment of thyroid-related ophthalmopathy.The literatures were screened strictly according to the inclusion and exclusion criteria,the quality of the included literatures,the risk of excursion was evaluated,the required data were extracted and arranged,and Rev Man5.3 software was used for meta-analysis.Result:A total of 1052 documents were obtained after preliminary search.Among them,342 articles were duplicated,and 619 articles were excluded after reading the title and abstract.After reading the full text,75 articles were excluded,of which 5 articles were repeatedly published.A total of 15 RCT literatures were included in the study(citation)(Figure 1),of which 5 were Chinese literatures and 10 were English literatures;7 literatures were controlled by oral prednisone and 2 literatures were controlled by prednisone The control group consisted of one document each for oral methylprednisolone,mycophenolate mofetil,and rituximab,and the control group consisted of one document each for optic nerve decompression and intravenous infusion of normal saline.There were 425 people in the experimental group and 424 people in the control group.Because most of the study administration methods were intravenous versus oral,no one was blinded to the subject except one of the studies.Meta analysis results are as follows:The efficacy of methylprednisolone venous impingement in the treatment of thyroid-related ophthalmopathy;1.The overall effectiveness of methylprednisolone vein pulse therapy for thyroid-related ophthalmopathy: a total of 5 articles reported the overall effectiveness,and the control group were all oral glucocorticoids.The heterogeneity test results showed that there was no obvious heterogeneity(I2 = 0%)between the studies,and the fixed effect model was used for analysis.The combined effects showed that the effect of methylprednisolone vein impact was significantly better than oral prednisone(RR = 1.40,95% CI(1.23-1.60,P <0.00001)).2.Improvement of the CAS score of methylprednisolone intravenous treatment for thyroid-related ophthalmopathy: a total of 8 articles.The control group was all oral glucocorticoids.The combined heterogeneity test of the results was I2 = 69%,suggesting that there are certain The heterogeneity of the data was analyzed using a random effects model.The results showed that in terms of lowering the CAS score,methylprednisolone pulse therapy was significantly better than oral prednisone(MD =-1.05,95% CI(-1.29--0.82),P <0.00001).3.The improvement of the width of the eye crack in the treatment of thyroid-related ophthalmopathy with methylprednisolone vein impact: A total of 4articles reported the changes in the width of the eye crack.The heterogeneity test results showed no obvious heterogeneity(I2 = 0%),and the fixed effect model was used for analysis.The combined effect results showed that there was no significant difference between the experimental group and the control group in improving the width of eye cracks(MD =-0.17,95% CI(-0.54-0.20,P = 0.36)).4.The improvement of exophthalmos in the treatment of thyroid-related ophthalmopathy by the impact of methylprednisolone veins: a total of 7 articles in the literature reported the improvement of exophthalmos.The heterogeneity test results show that there is a large heterogeneity(I2 = 74%),using random effects model for analysis.Meta analysis of the combined effect size showed that there was no significant difference between the experimental group and the control group in terms of improvement in exophthalmos(MD =-0.11,95% CI(-0.46-0.24,P = 0.55)).The safety of methylprednisolone for thyroid-associated ophthalmopathy: Based on the reports of adverse reactions reported in the literature included in this study,five major adverse reaction outcomes were analyzed: elevated blood glucose,elevated blood pressure,adverse reactions to the digestive system,and weight Cushing syndrome.The results showed no significant differences between the experimental group and the control group in terms of elevated blood glucose,adverse reactions to the digestive system,and weight gain(a.RR = 1.72,95% CI(0.84-3.55),c.RR = 0.57,95% CI(0.26-1.26),d.RR = 0.97,95% CI(0.15-6.18)),and the incidence of blood pressure and two adverse reactions of Cushing's syndrome were higher in the experimental group than in the control group(b.RR = 0.29,95% CI(0.10-0.87),e.RR = 0.21,95%CI(0.11-0.39)).Conclusion:Methylprednisolone intravenous shock is safer for thyroid-associated ophthalmopathy.