July 12, 2013
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Relapse rates higher with antithyroid drugs in Graves’ disease

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Relapse rates appear to be higher with antithyroid drugs vs. other treatment options for Graves’ disease, and there is a lack of high-quality evidence comparing these therapies, a recent meta-analysis suggests.

To determine these rates and to understand adverse events associated with antithyroid drugs, Vishnu Sundaresh, MD, clinical fellow of endocrinology and metabolism at Louisiana State University Health Sciences Center Hospital, and colleagues analyzed data from eight studies including 1,402 patients from five continents. The mean follow-up duration was 57 months for patients using antithyroid drugs, 64 months for those who underwent radioactive iodine (RAI) therapy, and 59 months for those who underwent thyroidectomy.

Vishnu Sundaresh, MD 

Vishnu Sundaresh

“We conducted a systemic review and network analysis of the three therapeutic options for the treatment of Graves’ hyperthyroidism in order to inform the patient-physician discussion regarding choice of therapy and to determine the quality of evidence available in the literature supporting the efficacy of these therapies,” researchers wrote.

Based on the network meta-analysis, data indicate greater relapse rates with antithyroid drugs compared with RAI (OR=6.25; 95% CI, 2.40-16.67) and with antithyroid drugs compared with thyroidectomy (OR=9.09; 95% CI, 4.65-19.23). The researchers found no significant difference in relapse rates among patients who underwent RAI vs. those who underwent thyroidectomy.

An examination of 31 cohort studies showed that 13% of patients experienced adverse events related to antithyroid drugs. The adverse events associated with methimazole (Tapazole, King Pharmaceuticals) largely involved dermatologic complications, while adverse events associated with propylthiouracil more often included hepatic effects, according to data.

However, the studies were considered to be low-quality and at moderate to high risk for bias, researchers wrote.

These findings could spark discussion between clinicians and patients regarding a choice of therapy, researchers wrote, but more high-quality studies and randomized, controlled trials are warranted.

Disclosure: The researchers report no relevant financial disclosures.