Haemorheopheresis in the treatment of Graves' ophtalmopathy: A randomized study
Michal Skacha1, Vera Ceeova2, Jan Cap2, Petr Vlcek1, Milan Blaha2 & Pavel Rezek1
The aim of this study was to perform a randomized study to evaluate the role of haemorheopheresis in the treatment of severe thyroid associated ophtalmopathy (TAO). Twenty patients were enrolled. All patients were treated with methylprednisolone i.v. pulses (Solumedrol 1 g i.v. three times a week for 3 weeks 9 pulses altogether). Ten randomly chosen patients were also subjected to haemorheopheresis (twice weekly for 2 weeks and than once in 3 weeks 10 procedures altogether).
The procedure proved to be safe. All immunoglobulin classes as well as autoantibodies directed against thyroglobulin, thyroidal peroxidase and TSH receptor statistically significantly decreased. Markers of cell mediated immunity soluble antigen CD30, monocyte chemotactic protein 1 decreased, but serum levels of CD40 ligand and soluble protein Fas/Apo-1 did not change significantly. Adhesion molecules selectin and endoglin decreased only insignificantly.
Clinical activity score (CAS) dropped more rapidly in patients treated with haemorheopheresis (from 3.6 before treatment to 0.6 after one month) than in patients treated with glucocorticoid pulses only (from 4 to 2 after one month). The CAS difference between the two groups was statistically significant (P=0.027). After three months the CAS was already low in both groups.
Amplitude of visual evoked potentials (VEP) improved after three months in haemorheopheresis group only. At the end of the study, there was no difference between patients treated with haemorheophereses and control group. Eye muscle width and proptosis measured by CT scan did not differ between the two groups.
We conclude that haemorheopheresis has only limited role in the treatment of TAO. It can decrease disease activity more rapidly than standard high dose i.v. glucocorticoid therapy. However, the final clinical outcome after longer time period did not differ significantly.