Patterns of Use, Efficacy, and Safety of Treatment Options for Patients with Graves' Disease: A Nationwide Population-Based Study
Patterns of Use, Efficacy, and Safety of Treatment Options for Patients with Graves' Disease: A Nationwide Population-Based Study
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DOI：
10.1089/thy.2019.0132
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发表时间：
2020-02-26
期刊：
影响因子：
6.6
通讯作者：
Stan, Marius N.
中科院分区：
文献类型：
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作者：
Brito, Juan P.;Payne, Stephanie;Stan, Marius N.
背景：Graves病(GD)治疗方案的使用模式及其相对有效性和安全性仍存在相当大的不确定性。方法：在2005至2013年间，我们确定了接受抗甲状腺药物(ATDS)、放射性碘(RAI)或手术的GD患者，并出现在美国的大型管理数据集中(Opums(R)Data Warehouse)。结果：我们确定了4661名GD患者：平均年龄48岁(SD+/-14)，白人(63%)，女性(80%)。ATD组2817例(60%)，RAI组1549例(33%)，手术组295例(6%)。ATD的成功率为50%，RAI的成功率为93%，手术的成功率为99%。ATD治疗失败的中位时间为6.8个月，RAI和手术治疗失败的中位时间为3个月。当患者被要求在评估失败之前至少服用ATD一年时，失败率下降到25%。接受ATD治疗的患者中有12%出现不良反应，接受RAI治疗的患者中有6%出现不良反应，接受手术治疗的患者中有24%发生不良反应。与治疗成功相关的因素有年龄，55岁(对于ATD)和女性(对于RAI)。在接受ATD治疗的患者中，大约有12%的患者在最初的治疗中继续这种治疗24个月。当患者ATD治疗失败时，最常见的二线治疗是再次启动ATD(65%)、RAI(26%)和手术(9%)。总体而言，26%的患者仍在接受ATD治疗(合并一线或二线)。结论：ATD治疗是最常见的GD治疗方法，显示出最低的疗效和罕见的显著不良反应。随着四分之一的患者仍在接受ATD治疗(初始或第二种治疗)，确定这种治疗方法的长期有效性、安全性、成本和负担变得势在必行。
Background: Considerable uncertainty remains about the pattern of use of treatment options for Graves' disease (GD) and their comparative effectiveness and safety.Methods: Between 2005 and 2013, we identified patients with GD who received antithyroid drugs (ATDs), radioactive iodine (RAI) or surgery, and were represented in a large administrative data set in the United States (OptumLabs(R) Data Warehouse).Results: We identified 4661 patients with GD: mean age 48 (SD +/- 14) years, white (63%), and female (80%). Patients received ATD, n = 2817 (60%), RAI, n = 1549 (33%), or surgery, n = 295 (6%). Success rates were 50% for ATD, 93% for RAI, and 99% for surgery. Median time to treatment failure was 6.8 months for ATD and 3 months for RAI and surgery. When patients were required to be on ATD for at least one year before assessing failure, the failure rate decreased to 25%. Adverse effects occurred in 12% of patients receiving ATD, 6% with RAI, and 24% with surgery. Factors associated with treatment success were age >55 years (for ATD) and female sex (for RAI). About 12% of patients receiving ATD continued this treatment for >24 months as initial therapy. When patients failed ATD therapy, the most common second-line therapy was reinitiation of ATD (65%), RAI (26%), and surgery (9%). Overall, 26% of patients remain on ATD therapy (combined first or second line).Conclusions: ATD therapy was the most common GD therapy and demonstrated the lowest efficacy and infrequent significant adverse effect profile. With one fourth of patients remaining on ATD treatment (initial or second modality treatment), it becomes imperative to determine the long-term efficacy, safety, costs, and burdens of this modality of treatment.