Evidence map›Paper›PMID 34007144›Full record

ArticleClinical ophthalmology (Auckland, N.Z.)2021

Real-World Efficacy and Safety of Mycophenolate Mofetil in Active Moderate-to-Sight-Threatening Thyroid Eye Disease.

Nicole Quah Qin Xian, Ahmed Alnahrawy, Rashmi Akshikar, Vickie Lee

Abstract read
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In one paragraph

Article in Clinical ophthalmology (Auckland, N.Z.), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

18 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
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  6. Article
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  8. Article
  9. Article
  10. The role of mycophenolate mofetil in the therapy of thyroid eye disease.Therapeutic advances in endocrinology and metabolism · 2025
    Review
  11. Review
  12. Review
  13. Dysthyroid optic neuropathy: emerging treatment strategies.Journal of endocrinological investigation · 2023
    Review
  14. Article
  15. Article
  16. Current concepts regarding Graves' orbitopathy.Journal of internal medicine · 2022
    Review
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  18. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Nicole Quah Qin XianDepartment of Stroke Medicine, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
Ahmed AlnahrawyDepartment of Ophthalmology, Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK.
Rashmi AkshikarDepartment of Ophthalmology, Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK.
Vickie LeeDepartment of Ophthalmology, Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK.ORCID 0000-0002-2963-5742

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThere is no universal consensus on second-line agents for the treatment of moderate/severe to sight-threatening thyroid eye disease (TED) to maintain remission after first-line intravenous methylprednisolone (IVMP). This study investigates the efficacy and safety of mycophenolate mofetil (MMF) in TED patients in a real-world setting and over a longer period than previous randomized controlled trials.

methodsA retrospective cohort study of TED patients with active moderate/severe to sight-threatening TED seen over a 4-year period. Data collected were visual acuity (VA), Clinical Activity Score (CAS), Gorman Diplopia scores, MMF dosing and side effects at 24, 52 and 78 weeks. Clinical efficacy was defined as an absence of relapse: no decline in best corrected LogMAR VA, no need for further steroids, no increase in CAS of ≥2.

resultsOut of 23 patients, 20 patients were included in this study. 10% (2/20) stopped MMF before 24 weeks. Median duration of MMF treatment was 76 weeks (1-140 weeks). 55% (11/20) had dysthyroid optic neuropathy (DON). In those with active moderate-severe TED without DON, clinical efficacy was seen in 100% (8/8) at 24 weeks, 87.5% (7/8) at 52 weeks, and 83.3% (5/6) at 78 weeks, with CAS decreasing from a baseline of 2.78±1.99 to 0.50±0.58 at 24 weeks, 0.50±0.82 at 52 weeks and 1.00±1.30 at 78 weeks. In DON, improvements were seen in 90% (9/10) at 24 weeks, 100% (7/7) at 52 weeks and 100% (4/4) at 78 weeks, with significantly reduced CAS scores from 2.55±1.54 to 0.83±1.27, 1.00±1.17 and 0.63±0.95 at 24, 52 and 78 weeks, respectively. Gorman score, VA and soft tissue inflammation parameters also improved throughout. There were two significant side effects over the treatment period.

conclusionMMF appears to be an effective and safe second-line immunosuppressive agent. Further studies aimed at elucidating optimal dosing regimens and ideal treatment duration will prove helpful.

Indexed as

CellCeptdysthyroid optic neuropathyGraves orbitopathy

Identifiers

PMID34007144
PMCPMC8121682

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.