Selenium and the Course of Mild Graves' Orbitopathy

Marcocci, Claudio; Kahaly, George J.; Krassas, Gerasimos E.; Bartalena, Luigi; Prummel, Mark; Stahl, Matthias; Altea, Maria Antonietta; Nardi, Marco; Pitz, Susanne; Boboridis, Kostas; Sivelli, Paolo; von Arx, George; Mourits, Maarten P.; Baldeschi, Lelio; Bencivelli, Walter; Wiersinga, Wilmar
May 2011
New England Journal of Medicine;5/19/2011, Vol. 364 Issue 20, p1920
Academic Journal
Background: Oxygen free radicals and cytokines play a pathogenic role in Graves' orbitopathy. Methods: We carried out a randomized, double-blind, placebo-controlled trial to determine the effect of selenium (an antioxidant agent) or pentoxifylline (an antiinflammatory agent) in 159 patients with mild Graves' orbitopathy. The patients were given selenium (100 �g twice daily), pentoxifylline (600 mg twice daily), or placebo (twice daily) orally for 6 months and were then followed for 6 months after treatment was withdrawn. Primary outcomes at 6 months were evaluated by means of an overall ophthalmic assessment, conducted by an ophthalmologist who was unaware of the treatment assignments, and a Graves' orbitopathy�specific quality-of-life questionnaire, completed by the patient. Secondary outcomes were evaluated with the use of a Clinical Activity Score and a diplopia score. Results: At the 6-month evaluation, treatment with selenium, but not with pentoxifylline, was associated with an improved quality of life (P<0.001) and less eye involvement (P=0.01) and slowed the progression of Graves' orbitopathy (P=0.01), as compared with placebo. The Clinical Activity Score decreased in all groups, but the change was significantly greater in the selenium-treated patients. Exploratory evaluations at 12 months confirmed the results seen at 6 months. Two patients assigned to placebo and one assigned to pentoxifylline required immunosuppressive therapy for deterioration in their condition. No adverse events were evident with selenium, whereas pentoxifylline was associated with frequent gastrointestinal problems. Conclusions: Selenium administration significantly improved quality of life, reduced ocular involvement, and slowed progression of the disease in patients with mild Graves' orbitopathy. (Funded by the University of Pisa and the Italian Ministry for Education, University and Research; EUGOGO Netherlands Trial Register number, NTR524.) N Engl J Med 2011;364:1920-31.


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