A Phase III, Randomized, Controlled, Open Label, no Profit, Single-center Intervention Study to Compare the Effect of a Conservative (Antithyroid Drugs) and an Ablative Approach (Radioiodine or Total Thyroidectomy) for the Treatment of Hyperthyroidism in Patients With Graves' Disease and Moderate-to-severe and Active Graves' Orbitopathy (GO) Treated With Intravenous Glucocorticoids (ABLAGO Study)
试验速览
- 阶段
- 3 期
- 状态
- 招募中
- 入组人数
- 52
- 试验地点
- 1
- 主要终点
- Overall GO outcome
研究概览
简要总结
Graves' disease (GD) is the most frequent cause of hyperthyroidism in iodine sufficient countries and Graves' orbitopathy (GO) is its most common extrathyroidal manifestation. Restoration and maintenance of euthyroidism are imperative in Graves' disease patients with GO. The main treatment options for Graves' hyperthyroidism are antithyroid drugs, radioactive iodine (RAI), and surgery. Whether one or the other therapy for Graves' hyperthyroidism offers the best protection against GO is not established. The study is aimed at comparing the effects of a conservative approach (antithyroid drugs, ATDs, experimental arm) vs an ablative approach (radioiodine or total thyroidectomy) of thyroid treatment on the overall outcome of GO in patients with GD and moderate-to-severe and active GO treated with intravenous glucocorticoids.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 75 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients willing and capable of giving written informed consent, which includes compliance with the requirements and restrictions listed in the consent form
- •A diagnosis of Graves' disease based on the presence of hyperthyroidism associated with detectable anti-thyrotropic hormone (TSH) receptor autoantibodies (TRAb). Patients must be euthyroid under control on stable medical regimen and every effort will be made to maintain the euthyroid status for the entire duration of the clinical trial.
- •Duration of Graves' disease shorter than 18 months
- •A moderate-to-severe GO, defined as the presence of at least one of the following criteria in the most affected eye: an exophthalmos ≥2 mm compared with normal values for sex and race; presence of inconstant to constant diplopia; a lid retraction ≥2 mm
- •Active GO: CAS ≥ 3 out of 7 points in the most affected eye. Taking into account severity (moderate-to-severe) and activity (CAS ≥ 3/7) of GO, patients are eligible for methylprednisolone treatment according to clinical practice.
- •Duration of GO shorter than 18 months
- •Male and female patients of age 18-75 years
- •Compliant patient, regular follow-up possible
排除标准
- •Optic neuropathy
- •Previous therapy for Graves' disease with radioiodine or thyroidectomy
- •Corticosteroids or other immunosuppressive treatment for GO or other reasons in the last 3 months.
- •Previous surgical treatment and/or radiotherapy for GO
- •Contraindications to GC: hypersensitivity to the active substance or to any of the excipients; uncontrolled hypertension, uncontrolled diabetes; history of peptic ulcer; urinary infections, glaucoma, systemic fungal infections, systemic infections unless appropriate therapy is employed, idiopathic thrombocytopenic purpura, cerebral edema associated with malaria.
- •Use of medications interfering with GC or increasing the risk of GC-related adverse events (see prohibited therapies)
- •Acute or chronic liver disease
- •Contraindications to ATD: hypersensitivity to the active substance or to any of the excipients; breastfeeding
- •Women of childbearing potential (WOCBP, namely not in menopause or in menopause since less than two years; in all other instances women will be considered as non-WOCBP) and men who are sexually active with WOCBP must use any contraceptive method with a failure rate of less than 1% per year (as indicated in Appendix) for at least 6 and 7,5 months, respectively, after the last dose of the investigational drug (see also 2014_09_HMA_CTFG_Contraception.pdf, namely the "2014 CTFG Reccommendtions related to contraception and pregnancy testing in clinical trials")
- •Contraindications of any kind to perform thyroidectomy
- •Mental illness that prevent patients from comprehensive, written informed consent
研究组 & 干预措施
Methimazole
Antithyroid drugs (at individualized dosage) for 72 weeks and a cumulative dose of 4.5 g of methylprednisolone divided into 12 weekly infusions
干预措施: Methimazole (Drug)
Thyroid ablation
Radioiodine therapy or total thyroidectomy (according to ultrasound thyroid volume) and a cumulative dose of 4.5 g of methylprednisolone divided into 12 weekly infusions
干预措施: Radioiodine or thyroidectomy (Procedure)
结局指标
主要结局
Overall GO outcome
时间窗: 24 weeks
Improvement is defined as change in two of the following outcome measures in at least one eye, without deterioration in any of the same measures in both eyes (compared to baseline): * Improvement in CAS by at least 2 points * Improvement in exophthalmos by at least 2 mm (Hertel exophthalmometer) * Improvement in lid aperture by at least 2 mm * Improvement in diplopia (disappearance or change in the degree) * Improvement of visual acuity by at least 0.2/1 Patients meeting the improvement criteria will be considered as "responders". All other patients will be considered as "non-responders".
次要结局
- Quality of life questionnaire(24, 48 and 72 weeks)
- Response of individual GO parameters: proptosis, CAS, eyelid width, diplopia, and visual acuity(24, 48 and 72 weeks)
- Overall GO outcome(72 weeks)
研究者
Marinò Michele
Associate Professor
University of Pisa