Effectiveness of Somatostatin Analogs versus Placebo for Graves’ Ophthalmopathy: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

SHI Shaomin ,  HE Yebing

Department of Endocrinology, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China;

Corresponding author：

HE Yebing, Email: mr.heyebing@163.com

Keywords：

Graves’ ophthalmopathy; Somatostatin analogs; CAS; Proptosis; Meta-analysis

DOI：

10.7507/1672-2531.20130019

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To systematically evaluate the effectiveness of somatostatin analogs versus placebo for Graves’ ophthalmopathy (GO).
Methods 　Such databases as PubMed, EMbase, The Cochrane Library, WanFang Data, CNKI, VIP and CBM were searched to collect the randomized controlled trails (RCTs) about somatostatin analogs for Graves’ Ophthalmopathy (GO) pulished by March 2012, while the bibliographies of the included literatue were also retrieved. According to the inclusion criteria, two reviewers screened literature, extracted data and assessed the quality of the included studies. Then meta-analysis was conducted using RevMan 5.0 software.
Results 　A total of 5 RCTs involving 210 patients were included. The results of meta-analysis showed that somatostatin analogs could reduce the clinical activity score (CAS) of GO patients (MD=0.58, 95%CI 0.02 to1.13, P=0.04), but the effects in reducing the degree of proptosis (mm) was still unverifiable (MD=0.21, 95%CI –0.14 to 0.56, P=0.24). It did not show obvious effects for diplopia, orbital volume, intraocular pressure, visual acuity or the restriction of eye movements. The existing evidence could not confirm that somatostatin analogs were effective for GO (OR=1.32, 95%CI 0.45 to 3.9, P=0.61).
Conclusion 　Somatostatin analogs can reduce the CAS of GO patients, but without significantly clinical significance. Moreover, the effect of reducing proptosis is sitll unverifiable. So the existing evidence cannot confirm that somatostatin analogs are effective for GO. For the quality and quantity limitation of the included studies, this conclusion needs to be proved by performing more high quality RCTs.

Citation： SHI Shaomin,HE Yebing. Effectiveness of Somatostatin Analogs versus Placebo for Graves’ Ophthalmopathy: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2013, 13(1): 106-111. doi: 10.7507/1672-2531.20130019 Copy

1.	Bartalena L, Baldeschi L, Dickinson A, et al. Consensus statement of the European Group on Graves’ orbitopathy (EUGOGO) on management of GO. European Journal of Endocrinology, 2008, 158: 273-285.
2.	Bartalena L, Marcocci C, Tanda ML, et al. An update on medical management of Graves’ ophthalmopathy. J Endocrinol Invest, 2005, 28: 469-478.
3.	Bartalena L, Marcocci C, Pinchera A. Editorial: Somatostatin analogs for Graves’ ophthalmopathy - Do they bounce off like a rubber bullet? J Clin Endocrinol Metab, 2004, 89(12): 5908-5909.
4.	Kung AW, Michon J, Tai KS, et al. The effect of somatostatin versus corticosteroid in the treatment of Graves’ ophthalmopathy. Thyroid, 1996, 6(5): 381-384.
5.	Krassas GE, Dumas A, Pontikides N, et al. Somatostatin receptor scintigraphy and octreotide treatment in patients with thyroid eye disease. Clin Endocrinol, 1995, 42: 571-580.
6.	Wemeau JL, Caron P, Beckers A, et al. Octreotide (long-acting release formulation) treatment in patients with Graves’ orbitopathy: clinical results of a four-month, randomized, placebo-controlled, double-blind study. J Clin Endocrinol Metab, 2005, 90(2): 841-848.
7.	Chang TC, Liao SL. Slow-release lanreotide in Graves’ ophthalmopathy: A double-blind randomized, placebo-controlled clinical trial. J Endocrinol Invest, 2006, 29: 413-422.
8.	Stan MN, Garrity JA, Bradley EA, et al. Randomized, double-blind, placebo-controlled trial of long-acting release octreotide for treatment of Graves’ ophthalmopathy. J Clin Endocrinol Metab, 2006, 91(12): 4817-4824.
9.	Dickinson AJ, Vaidya B, Miller M, et al. Double-blind, placebo-controlled trial of octreotide long-acting repeatable (LAR) in thyroid-associated ophthalmopathy. J Clin Endocrinol Metab, 2004, 89(12): 5910-5915.
10.	Julian PT, Sally G (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. Available from: http://www.cochrane-handbook.org.
11.	Krassas GE, Kaltsas T, Dumad A, et al. Lanreotide in the treatment of patients with thyroid eye disease. European journal of endocrinology, 1997, 136: 416-422.
12.	Cozma I, Zhang L, Uddin J, et al. Modulation of expression of somatostatin receptor subtypes in Graves’ ophthalmopathy orbits: relevance to novel analogs. Am J Physiol Endocrinol Metab, 2007, 293: E1630-E1635.
13.	孙斌, 张朝霞. 生长抑素类药物治疗甲状腺相关性眼病的研究进展. 国际眼科纵览, 2011, 35(5): 303-306.
14.	刘志民李顾沈. 生长抑素类似物对Graves眼病治疗作用的Meta分析. 第二军医大学学报, 2004, 25(4): 426-430.
15.	Krassas GE, Doumas A, Kaltsas T, et al. Somatostatin receptor scintigraphy before and after treatment with somatostatin analogues in patients with thyroid eye disease. Thyroid, 1999, 9(1): 47-52.
16.	Pichler R, Maschek W, Holzinger C. Therapy with somatostatin analogs in patient with orbitopathy and positive Octreoscan. Acta Med Austriaca, 2001, 28: 99-101.

1. Bartalena L, Baldeschi L, Dickinson A, et al. Consensus statement of the European Group on Graves’ orbitopathy (EUGOGO) on management of GO. European Journal of Endocrinology, 2008, 158: 273-285.
2. Bartalena L, Marcocci C, Tanda ML, et al. An update on medical management of Graves’ ophthalmopathy. J Endocrinol Invest, 2005, 28: 469-478.
3. Bartalena L, Marcocci C, Pinchera A. Editorial: Somatostatin analogs for Graves’ ophthalmopathy - Do they bounce off like a rubber bullet? J Clin Endocrinol Metab, 2004, 89(12): 5908-5909.
4. Kung AW, Michon J, Tai KS, et al. The effect of somatostatin versus corticosteroid in the treatment of Graves’ ophthalmopathy. Thyroid, 1996, 6(5): 381-384.
5. Krassas GE, Dumas A, Pontikides N, et al. Somatostatin receptor scintigraphy and octreotide treatment in patients with thyroid eye disease. Clin Endocrinol, 1995, 42: 571-580.
6. Wemeau JL, Caron P, Beckers A, et al. Octreotide (long-acting release formulation) treatment in patients with Graves’ orbitopathy: clinical results of a four-month, randomized, placebo-controlled, double-blind study. J Clin Endocrinol Metab, 2005, 90(2): 841-848.
7. Chang TC, Liao SL. Slow-release lanreotide in Graves’ ophthalmopathy: A double-blind randomized, placebo-controlled clinical trial. J Endocrinol Invest, 2006, 29: 413-422.
8. Stan MN, Garrity JA, Bradley EA, et al. Randomized, double-blind, placebo-controlled trial of long-acting release octreotide for treatment of Graves’ ophthalmopathy. J Clin Endocrinol Metab, 2006, 91(12): 4817-4824.
9. Dickinson AJ, Vaidya B, Miller M, et al. Double-blind, placebo-controlled trial of octreotide long-acting repeatable (LAR) in thyroid-associated ophthalmopathy. J Clin Endocrinol Metab, 2004, 89(12): 5910-5915.
10. Julian PT, Sally G (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. Available from: http://www.cochrane-handbook.org.
11. Krassas GE, Kaltsas T, Dumad A, et al. Lanreotide in the treatment of patients with thyroid eye disease. European journal of endocrinology, 1997, 136: 416-422.
12. Cozma I, Zhang L, Uddin J, et al. Modulation of expression of somatostatin receptor subtypes in Graves’ ophthalmopathy orbits: relevance to novel analogs. Am J Physiol Endocrinol Metab, 2007, 293: E1630-E1635.
13. 孙斌, 张朝霞. 生长抑素类药物治疗甲状腺相关性眼病的研究进展. 国际眼科纵览, 2011, 35(5): 303-306.
14. 刘志民李顾沈. 生长抑素类似物对Graves眼病治疗作用的Meta分析. 第二军医大学学报, 2004, 25(4): 426-430.
15. Krassas GE, Doumas A, Kaltsas T, et al. Somatostatin receptor scintigraphy before and after treatment with somatostatin analogues in patients with thyroid eye disease. Thyroid, 1999, 9(1): 47-52.
16. Pichler R, Maschek W, Holzinger C. Therapy with somatostatin analogs in patient with orbitopathy and positive Octreoscan. Acta Med Austriaca, 2001, 28: 99-101.

Chinese Journal of Evidence-Based Medicine

Effectiveness of Somatostatin Analogs versus Placebo for Graves’ Ophthalmopathy: A Meta-Analysis

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