Objective To systematically evaluate the effectiveness of somatostatin analogs versus placebo for Graves’ ophthalmopathy (GO). Methods Such databases as PubMed, EMbase, The Cochrane Library, WanFang Data, CNKI, VIP and CBM were searched to collect the randomized controlled trails (RCTs) about somatostatin analogs for Graves’ Ophthalmopathy (GO) pulished by March 2012, while the bibliographies of the included literatue were also retrieved. According to the inclusion criteria, two reviewers screened literature, extracted data and assessed the quality of the included studies. Then meta-analysis was conducted using RevMan 5.0 software. Results A total of 5 RCTs involving 210 patients were included. The results of meta-analysis showed that somatostatin analogs could reduce the clinical activity score (CAS) of GO patients (MD=0.58, 95%CI 0.02 to1.13, P=0.04), but the effects in reducing the degree of proptosis (mm) was still unverifiable (MD=0.21, 95%CI –0.14 to 0.56, P=0.24). It did not show obvious effects for diplopia, orbital volume, intraocular pressure, visual acuity or the restriction of eye movements. The existing evidence could not confirm that somatostatin analogs were effective for GO (OR=1.32, 95%CI 0.45 to 3.9, P=0.61). Conclusion Somatostatin analogs can reduce the CAS of GO patients, but without significantly clinical significance. Moreover, the effect of reducing proptosis is sitll unverifiable. So the existing evidence cannot confirm that somatostatin analogs are effective for GO. For the quality and quantity limitation of the included studies, this conclusion needs to be proved by performing more high quality RCTs.
Graves’ ophthalmopathy (GO) is an autoimmune disease, and there is no specific treatment drug. Glucocorticoid (GC) therapy is still the first-line therapy for patients with moderate to severe GO. Targeted therapy may become a novel treatment due to GC’s adverse drug reactions. As the in-depth study of the pathogenesis of GO, many targeted drugs with randomized clinical trial (RCT) treatment have appeared in recent years, such as anti-insulin growth factor 1 receptor (teprotumumab), anti-CD20 (rituximab) and anti-interleukin(IL)-6 receptor (tocilizumab). It is worth noting that teprotumumab has been approved by US Food and Drug Administration in recently, and may quickly become the first-line therapy for GO. The anti-B cell stimulating factor (belimumab) which is undergoing RCT is waiting for the result of RCT to reveal. Anti-tumor necrosis factor-α (such as etanercept, adalimumab, and infliximab) which only used in case reports requires RCT further verification. In addition, anti-IL-17/IL-23, thyroid stimulating hormone receptor, CD40 targets and target therapies may have potential clinical value for GO due to the successful use of these target therapies in vitro experiments and other autoimmune diseases. This paper focus on the progress of targeted therapy of GO in China and abroad in recent years.