Factors associated with the efficacy of intravenous methylprednisolone in moderate-to-severe and active thyroid-associated ophthalmopathy: A single-centre retrospective study.

Abstract

Intravenous methylprednisolone (IVMP) is recommended as the first-line treatment for moderate-to-severe and active thyroid-associated ophthalmopathy (TAO). This study aimed to identify potential predictors and establish a multivariable prediction model for the efficacy of IVMP therapy. A single-centre retrospective study. A total of 302 consecutive patients diagnosed with moderate-to-severe and active TAO who underwent the full course of IVMP therapy were included. Participants were sequentially divided into the training set (n=200) and the validation set (n=102). Multivariate logistic regression analysis was used to identify the independent predictors and establish the predictive model. In addition to the pretreatment clinical activity score (OR=3.506, P<0.001), elevated thyroid-stimulating hormone (TSH) levels during treatment (OR=0.145, P=0.005), pretreatment anti-TSH receptor antibody levels (OR=0.061, P<0.001) and duration of eye symptoms (OR=0.878, P=0.017), a significant relationship was found between therapeutic efficacy and the pretreatment triglyceride levels (OR=0.090, P=0.001). The prediction model showed good calibration and excellent discrimination, with an area under curve of 0.915 (P<0.001) and 0.885 (P<0.001) in the training and validation sets, respectively. This study provides some novel insights into the factors associated with the efficacy of IVMP therapy. A multivariable prediction model has been established and validated to help determine the indication and prognosis of IVMP therapy. Moreover, several suggestions have been made in the management of TAO patients: early diagnosis and treatment (within 15months); prompt restoration and maintenance of euthyroidism, especially meticulous control of TSH levels (≤5μIU/mL); and regular monitoring of triglyceride levels.