This article is part of Ophthalmology Advisor’s conference coverage from the 2021 Fall Scientific Symposium of the American Society of Ophthalmic Plastic and Reconstructive Surgery, held in New Orleans from November 11 to 12, 2021. The team at Ophthalmology Advisor will be reporting on a variety of the research presented by the oculoplastic researchers and other clinicians at the ASOPRS. Check back for more from the ASOPRS 2021 Fall Scientific Symposium.
Intravenous (IV) glucocorticoid therapy is more effective than oral steroids as an initial treatment for IgG4-related ophthalmic disease (IgG4-ROD), researchers found in a report presented at the American Society of Ophthalmic Plastic and Reconstructive Surgery 52nd Annual Fall Scientific Symposium in New Orleans, November 11 to November 12.1
IgG4-ROD is a systemic condition that can create painless swelling of lacrimal glands and is often treated with corticosteroids or immunosuppressants.2 Oral glucocorticoids are typical forms of treatment, but relapse rates can be as high as 50%, leading to repetitive treatments and increased risk of adverse effects, patients’ noncompliance and more immunosuppressive treatments. The condition causes about one-third of cases of idiopathic orbital inflammation, and it can impact the orbital nerve.
Due to the success of IV therapy for thyroid ophthalmology in comparison with oral steroids, the researchers decided to put IV glucocorticoids to the test for IgG4-ROD, according to the ASOPRS presenters.
They retrospectively reviewed medical charts of patients who underwent either oral (n=36 eyes) or IV (n=24 eyes) systemic glucocorticoids therapy for the condition between June 2012 and June 2020 at Asan Medical Center in Seoul, South Korea. Patients were included based on biopsies that indicated IgG4-ROD. They had a follow-up period of at least 3 months, and then were routinely followed up with every 3 to 6 months.
Before December 2016, the oral steroid group utilized a 0.6 mg/kg/d dosage of prednisolone for 4 weeks, which was tapered by 5 mg every 2 to 4 weeks. Individuals in the IV steroid group took methylprednisolone for 6 weeks in either 500 mg per week doses or 250 mg per week doses and then tapered with an oral steroid.
The investigators found that the patients who took IV steroids had lower relapse rates and responded better to treatment compared with patients who took oral steroids, and adverse effects were not significantly different between the groups.
Seventeen of the 24 eyes (70.8%) in the IV steroid group and 7 of the 36 eyes (19.4%) in the oral steroid group experienced complete response (P <.001).
The most common adverse events in the IV steroid group were weight gain of 10% or more, hypertension, and insomnia. The oral steroid group experienced 6 cases of weight gain of at least 10%, 4 cases of Cushingoid feature, 2 cases of hypertension, and 1 case of insomnia.
The researchers concluded that IV glucocorticoid therapy for the condition is an “effective and safe choice as an initial treatment” and “better than oral steroids in response and relapse.”
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1. Yang MK, Kim GJ, S H-K. Efficacy and safety of intravenous corticosteroids as an initial treatment for IgG4-related ophthalmic disease. Poster presented at American Society of Ophthalmic Plastic and Reconstructive Surgery 52nd Annual Fall Scientific Symposium; November 11-12, 2021; New Orleans, LA.
2. Chelnis J, Gervasio KA. IgG4-related Orbital Inflammation. EyeWiki. Updates September 17, 2021. Accessed November 9, 2021.