Comparison of volumetric responses to different corticosteroid administration methods in IgG4-related ophthalmic disease

TL;DR

This study compares how different corticosteroid treatments affect the size of eye-related glands in a specific immune disease, finding that intravenous treatment is more effective than oral treatment.

Contribution

The study provides new evidence that intravenous corticosteroids offer better long-term results than oral ones for treating IgG4-related ophthalmic disease.

Findings

Intravenous methylprednisolone showed higher 2-year radiological relapse-free survival (80%) compared to oral prednisolone (37.5%).

Local triamcinolone injection had the highest relapse-free survival (100%) and comparable volume reduction to intravenous treatment.

Oral prednisolone resulted in significantly higher gland volume ratios post-treatment compared to intravenous and local treatments.

Abstract

To analyze the clinical and volumetric responses to different corticosteroid administration methods for IgG4-related ophthalmic disease (IgG4-ROD).

The medical records of patients with bilateral lacrimal gland (LG) enlargement diagnosed with IgG4-ROD through unilateral LG biopsy between January 2011 and January 2022 were retrospectively reviewed. Clinical signs and the non-biopsied LG volume across three administration routes were compared: oral prednisolone (Pd), intravenous (IV) methylprednisolone (methylPd), and local triamcinolone (TA) injection. Radiological relapse was defined as the first instance of failure to satisfy the radiological response criteria, i.e., a post-treatment volume of <1.0 cm3 or a post-treatment to pre-treatment volume ratio of <35%.

Among the 28 patients, eight, ten, and ten received oral Pd, IV methylPd, and local TA injection, respectively. No significant differences were observed between the groups in terms of the baseline characteristics. Ophthalmic adverse effects were not observed in any patient. Kaplan–Meier survival analysis revealed that the 2-year radiological relapse-free survival in the IV methylPd group (80.0%) was higher than that in the oral Pd group (37.5%, p = 0.036) but comparable with that in the local TA group (100.0%, p = 0.886). The median post-treatment to pre-treatment volume ratio in the IV methylPd group (35.4%) was significantly lower than that in the oral Pd group (75.0%, p = 0.042) but comparable with that in the local TA injection group (38.5%, p = 0.321) one year after treatment.

Compared with oral Pd, IV methylPd yielded better and more sustained radiological responses in patients with LG-involving IgG4-ROD. Local TA injection was also an effective alternative treatment option.

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