Comparation Between Weekly Regimens and Monthly Regimen Intravenous Methylprednisolone in Moderate To Severe and Active Graves’ Ophthalmopathy: A Systematic Review

Abstract

Background: Graves' ophtalmopathy (GO) is the most common extrathyroidal manifestation of Graves' disease, with approximately 22% of cases being active and moderate-to-severe, warranting immunosuppressive therapy. Intravenous Methylprednisolone (IVMP) are recommended as first-line treatment, with the EUGOGO 2021 weekly 4.5 g protocol over 12 weeks as the established standard. Monthly regimens have been proposed as an alternative with a reduced infusion burden. However, comparative evidence on the efficacy and safety of these two regimens remains limited and has not been systematically synthesized.

Methods: A systematic review was conducted following PRISMA 2020 guidelines. PubMed, Scopus, Cochrane Library, EuropePMC, and Epistomonikos. Two reviewers independently screened records, extracted data, and assessed methodological quality using the Cochrane Risk of Bias 2 (RoB 2) and Newcastle-Ottawa Scale.

Results: Six studies (n=307) were included. Weekly IVMP showed consistently higher response rates (77-86%) compared with monthly regimens (67-72%), although differences were not statistically significant in direct comparisons. Both regimens demonstrated superior efficacy over oral glucocorticoid (77% vs 51%) and placebo (83% vs 11%). Safety profiles were comparable between weekly and monthly regimens, with weight gain as the most common adverse event and no major hepatotoxicity or mortality reported.

Conclusion: Weekly and monthly IVMP treatments showed similar effectiveness and safety for patients with active moderate-to-severe Graves' ophtalmopathy. This means the monthly regimen can be a practical option, especially where infusion facilities are harder to access.