Methimazole-induced remission rates in pediatric Graves' disease: a systematic review

被引:32
|
作者
van Lieshout, Jelmer M. [1 ]
Mooij, Christiaan F. [1 ]
van Trotsenburg, A. S. Paul [1 ]
Zwaveling-Soonawala, Nitash [1 ]
机构
[1] Univ Amsterdam, Amsterdam Univ Med Ctr, Emma Childrens Hosp, Dept Pediat Endocrinol, Amsterdam, Netherlands
关键词
ANTITHYROID DRUG-TREATMENT; LONG-TERM OUTCOMES; INDUCED AGRANULOCYTOSIS; CHILDREN; HYPERTHYROIDISM; MANAGEMENT; ADOLESCENTS; THYROTOXICOSIS; DIAGNOSIS; PROPYLTHIOURACIL;
D O I
10.1530/EJE-21-0077
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: Comparison of studies on remission rates in pediatric Graves' disease is complicated by lack of uniformity in treatment protocols, remission definition, and follow-up duration. We performed a systematic review on remission rates in pediatric Graves' disease and attempted to create uniformity by recalculating remission rates based on an intention-to-treat analysis. Methods: PubMed and Embase were searched in August 2020 for studies on patients with Graves' disease: (i) 2 to 18 years of age, (ii) initially treated with methimazole or carbimazole for at least 18 months, (iii) with a follow-up duration of at least 1 year after cessation of methimazole or carbimazole. All reported remission rates were recalculated using an intention-to-treat analysis. Results: Of 1890 articles, 29 articles consisting of 24 patient cohorts were included with a total of 3057 patients (82.6% female). Methimazole or carbimazole was initially prescribed in 2864 patients (93.7%). Recalculation based on intention-to-treat analysis resulted in an overall remission rate of 28.8% (829/2880). Pooled remission rates based on treatment duration were 23.7, 31.0, 43.7, and 75% respectively after 1.5-2.5 years, 2.5-5 years, 5-6 years (two studies), and 9 years (single study) treatment duration. The occurrence of adverse events was 419 in 2377 patients (17.6%), with major side effects in 25 patients (1.1%). Conclusions: Using a standardized calculation, the overall remission rate in methimazole-treated pediatric GD is 28.8%. A few small studies indicate that longer treatment increases the remission rate. However, evidence is limited and further research is necessary to investigate the efficacy of longer treatment durations.
引用
收藏
页码:219 / 229
页数:11
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