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- W4322753423 abstract "The therapy of severe manifestations of Graves' orbitopathy (GO) is still a challenge and requires good interdisciplinary cooperation. It is especially important to use stage-adapted anti-inflammatory therapy to avoid irreversible damage.Discussion of the latest results of multicentre randomised therapy studies on anti-inflammatory treatments for Graves' orbitopathy, as well as new therapeutic concepts.Mild cases of GO can be treated with only selenium supplementation and a watchful waiting strategy. In the moderate-to-severe active form of GO, primary therapy consists of i. v. steroids (cumulative 4-5 g) in combination with orbital irradiation in patients with impaired motility. In patients with insufficient therapeutic response after 6 weeks, treatment should be switched to other immunosuppressive agents. In severe sight-threatening disease, bony orbital decompression is usually necessary. As basic research has improved our understanding of the underlying pathophysiology of GO, it has been possible to develop targeted therapies for GO. Teprotumumab, an IGF-1 receptor antibody, was effective in treating GO patients in a phase III trial and should soon be awarded approval for Europe.The current therapy concept for Graves' orbitopathy is as follows: first anti-inflammatory therapy then surgical correction of the permanent defects. This may soon be modified, due to the use of targeted therapies.Die Therapie schwerer Manifestationsformen der endokrinen Orbitopathie (EO) ist immer noch eine Herausforderung und verlangt eine gute interdisziplinäre Zusammenarbeit. Von besonderer Bedeutung ist die stadiengerechte antientzündliche Therapie, um irreversible Schäden zu vermeiden.Diskussion der neuesten Ergebnisse multizentrischer randomisierter Therapiestudien zur antientzündlichen Therapie der endokrinen Orbitopathie und von neuen Therapiekonzepten.Bei der milden Form der EO kann der Spontanverlauf unter Selensupplementation abgewartet werden. Bei der moderat schweren aktiven Form der EO besteht die Primärtherapie aus einer i. v. Steroidstoßtherapie (kumulativ 4–5 g) in Kombination mit einer Orbitaspitzenbestrahlung bei Motilitätsstörungen. Bei ungenügendem Ansprechen nach 6 Wochen kann eine immunsuppressive Therapie hinzugefügt werden. Bei schwerer visusbedrohender Manifestation ist meist eine knöcherne Orbitadekompression die Therapie der Wahl. Durch konsequente Grundlagenforschung konnten inzwischen auch für die EO zielgerichtete Therapien entwickelt werden. Der IGF-1-Rezeptor-Antikörper Teprotumumab zeigte sich in einer Phase-III-Studie als effektiv, sodass in Kürze mit einer Zulassung zu rechnen ist.Das aktuell noch gültige Therapiekonzept bei der endokrinen Orbitopathie der zunächst antientzündlichen Therapie gefolgt von der operativen Korrektur der bleibenden Defekte ändert sich möglicherweise durch den Einsatz zielgerichteter Therapien in der Zukunft." @default.
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- W4322753423 date "2023-03-01" @default.
- W4322753423 modified "2023-10-18" @default.
- W4322753423 title "Endokrine Orbitopathie: Aktueller Stand der medikamentösen Therapie" @default.
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- W4322753423 doi "https://doi.org/10.1055/a-1861-7315" @default.
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