FP28-2 Favorable effects of bromocriptine and pentoxifylline in the treatment of mild to moderate Graves' disease associated ophthalmopathy. A randomized, controlled, single blind, clinical trial

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: FP28-Thyroid Autoimmunity
Sunday, June 16, 2013: 10:45 AM-11:15 AM
Presentation Start Time: 10:50 AM
Room 103 (Moscone Center)

Poster Board SUN-435
Paloma Almeda-Valdes*, Daniel Cuevas-Ramos, Miguel Angel Gomez-Samano, Francisco Cardenas-Velazquez, Bernardo Perez-Enriquez, Arturo Abundes-Corona and Francisco Javier Gomez-Perez
Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
Introduction. Autoimmune ophtalmopathy is clinically evident in one third of Graves’ disease cases. In most cases it is mild; however, in 3 to 5% of cases it has a severe presentation. At present, the treatment is directed to identify vision threatening which requires aggressive intervention, usually with glucocorticoids. For mild cases the treatment is limited to the normalization of hyperthyroidism and support measures. Preliminary data show that pentoxifylline and bromocriptine may have a favorable effect in the course of ophtalmopathy by inhibition of the synthesis of TNF-α, VEGF, glycosaminoglycan production, and lymphocyte infiltration. Therefore, the aims of this study were to evaluate the effect of bromocriptine and pentoxifylline on the clinical course and quality of life of patients with mild to moderate ophtalmopathy associated to Graves´ disease.  

Methods. Patients with mild to moderate ophtalmopathy, with less than one year of evolution, and naive to treatment were randomized to receive treatment during 12 months with either 1) bromocriptine (5 mg twice a day) + methimazol (30 mg/day), 2) pentoxifylline (400 mg twice a day) + methimazol (30 mg/day), or 3) methimazol only (30 mg/day). They completed 10 visits to evaluate proptosis and clinical activity score (CAS).  In addition, in the first and last visit the quality of life questionnaire specific for Graves’ ophtalmopathy (GO-QOL) was applied.

Results. This is a preliminary report with the results of 25 patients that have concluded the study. Nine were assigned to group 1, eight to group 2, and eight to group 3. General characteristics and baseline measures did not differ between groups. At the end of treatment a favorable change in proptosis was documented in the group receiving bromocriptine (right eye 19.5 to 17.2 mm and left eye 19.2 to 17.1 mm, P<0.001 for both) and pentoxifylline (right eye 19.6 to 17.7 and left eye 19.7 to 18 mm, P= 0.006 for both) and not in the group receiving methimazol (right eye 19.4 to 18.6 mm, P= 0.22 and left eye 18 to 18.3, P= 0.47). A favorable change in the CAS was observed in all groups (P= 0.026, P= 0.011, and P= 0.011, respectively). The QOL score improved significantly in all groups (P= 0.011, P= 0.017, and P= 0.012).

Conclusions. Treatment of mild to moderate Graves’ associated ophtalmopathy with bromocriptine and pentoxfylline was associated with a significant, favorable change in proptosis. Improvement of CAS and QOL were observed with all treatments.

Nothing to Disclose: PA, DC, MAG, FC, BP, AA, FJG

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm