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Second course of antithyroid drugs effective after Graves’ disease relapse
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In adults with Graves’ disease treated with antithyroid drugs, a second course may be effective treatment after a first relapse, study data show.
However, low-dose maintenance of antithyroid drugs or ablative treatments should be considered in patients with more than two relapses or with an antithyroid drug treatment duration of more than 4 to 5 years, according to the researchers.
Young Joo Park, MD, PhD, of the department of internal medicine at Seoul University College of Medicine in Korea, and colleagues evaluated 187 adults (mean age at diagnosis, 38 years; 75.9% women) with newly diagnosed Graves’ disease who were treated with antithyroid drugs and had at least 4 years of follow-up to determine long-term disease prognosis and predictive factors for relapse. Follow-up was a median 11.1 years and participants received a median of two cycles of antithyroid drug treatment.
Through follow-up, 51.9% of participants achieved disease remission; 34.2% achieved final remission after the first cycle of treatment, 25.5% after the second and 17.1% after the third.
Following 2 years of treatment, the normal recommended duration, it was discontinued in 45.5% of participants after the first course, 42.9% after the second course and 28.6% after the third course.
Relapse rates increased with time and more than 90% of relapses occurred within 4 years after discontinuation of treatment.
Persistent disease was significantly associated with moderate to severe Graves’ ophthalmopathy (OR = 4.14; 95% CI, 1.13-15.17), increased relapse number (OR = 4.71; 95% CI, 2.27-9.78) and longer overall antithyroid drug treatment duration (OR = 1.43; 95% CI, 1.2-1.7).
“A [second] course of [antithyroid drug] treatment might be beneficial in patients who relapsed for the first time, as well as in newly diagnosed patients,” the researchers wrote. “Ablative treatment or low-dose maintenance of [antithyroid drug] might be considered in high-risk patients for persistent [Graves’ disease] who underwent more than two relapses or longer [antithyroid drug] treatment more than 4 or 5 years.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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