Abstract:
Objective To systematically evaluate the efficacy and safety of 131I+glucocorticoid (GC) in the treatment of Graves' ophthalmopathy (GO).
Methods PubMed, Embase, Cochrane Library, China National Knowledge Internet, and Wanfang data Knowledge Service Platform were searched for relevant studies on the use of 131I+GC treatment GO. The search time was from database establishment to July 20, 2021. They selected the literature and extracted the data according to the inclusion and exclusion criteria. Meta-analysis was performed with Stata 15.0 software to compare the efficacy of 131I+GC and 131I for treating Graves' hyperthyroidism (GH) complicated with GO in different periods, as well as to analyze the effects of intravenous injection and oral GC administration on the treatment of GO and its complications. The heterogeneity of an article was evaluated using P values of χ2 test and I2. The progression of GO was expressed by relative risk (RR). The publication bias and sensitivity of the included literature were analyzed by the Egger and clipping methods, and the therapeutic efficacy of the two methods was analyzed by the Z test.
Results Finally, a total of 22 articles were included, among which 15 were randomized controlled trials and 7 were cohort studies. The curative effect of 131I+GC was better than that of 131I in patients with GH complicated with GO, and the difference was statistically significant (Z=3.18, RR=0.37, 95%CI: 0.20–0.68, P=0.004). A standard dose of GC (0.3–0.5 mg/kg) can better prevent the progression of GO than a low-dose one (0.2–0.3 mg/kg). Different ways of drug use had little effect on the progress of GO prevention.
Conclusions 131I+GC treatment was effective in preventing the progression of GH complicated with GO, especially in active GO patients. A standard dose of GC can better control the progression of GO than a low-dose one, but at the same time produces more complications. Intravenous injection and oral administration of GC had the same effect on patients with GO after 131I treatment.