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Local Betamethasone Versus Triamcinolone Injection in Management of Thyroid Eye Disease

Primary Purpose

Thyroid Eye Disease

Status
Unknown status
Phase
Phase 4
Locations
Study Type
Interventional
Intervention
peri-levator betamethasone injection
peri-levator triamcinolone injection
peri-levator and retrobulbar betamethasone injection
peri-levator and retrobulbar triamcinolone injection
Sponsored by
Assiut University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Thyroid Eye Disease

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Clinical diagnosis of Thyroid Eye Disease.
  • Thyroid function within normal range.

Exclusion Criteria:

  • Patients on systemic steroid and or immunosuppressive therapy.
  • Patients underwent thyroidectomy.
  • Sight threatening (severe) TED which requires immediate surgery.
  • Patients with fibrotic ocular muscles who need surgery.
  • Contraindications to steroid therapy as in pregnant women.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm 3

    Arm 4

    Arm Type

    Experimental

    Experimental

    Experimental

    Experimental

    Arm Label

    A1 peri-levator betamethasone injection

    A2 Peri-levator triamcinolone acetate injection

    B1 Peri-levator and retrobulbar betamethasone injection

    B2 Peri-levator and retrobulbar triamcinolone acetate injection

    Arm Description

    patients with isolated thyroid-related upper lid retraction who will be given the Peri-levator injection of betamethasone suspension

    patients with isolated thyroid-related upper lid retraction who will be given Peri-levator injection of triamcinolone acetate

    patients with thyroid-related upper lid retraction and proptosis who will be given Peri-levator and retrobulbar injection of betamethasone suspension

    patients with thyroid-related upper lid retraction and proptosis who will be given Peri-levator and retrobulbar injection of triamcinolone acetate

    Outcomes

    Primary Outcome Measures

    to measure the change in MRD1 in mm using a ruler in all groups after peri-levator injection of different types of steroid
    The technique will be considered; 1) Effective if the MRD1 reaches the normal value< or= 4mm, 2) Partially effective if the MRD1 is improved but do not reach the normal values, 3) Ineffective if no improvement occur in MRD1
    to measure the change in proptosis in mm using Hertel's exophthalmometer in group B after retrobulbar injection of different types of steroid
    The technique will be considered; 1) Effective if the reading of Hertel's exophthalmometer reaches the normal value (16±2mm), 2) Partially effective if the proptosis is improved but do not reach the normal values, 3) Ineffective of no improvement occur in proptosis

    Secondary Outcome Measures

    to document any change in size of superior rectus levator complex and other extra-ocular muscles
    measuring size of superior rectus levator complex and other extra-ocular muscles before and after injections by orbital imaging techniques (CT or MRI).

    Full Information

    First Posted
    July 13, 2021
    Last Updated
    July 15, 2021
    Sponsor
    Assiut University
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    1. Study Identification

    Unique Protocol Identification Number
    NCT04976816
    Brief Title
    Local Betamethasone Versus Triamcinolone Injection in Management of Thyroid Eye Disease
    Official Title
    Local Betamethasone Versus Triamcinolone Injection in Management of Thyroid-Related Upper Lid Retraction With and Without Proptosis
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    July 2021
    Overall Recruitment Status
    Unknown status
    Study Start Date
    September 1, 2021 (Anticipated)
    Primary Completion Date
    December 2022 (Anticipated)
    Study Completion Date
    January 2023 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    Assiut University

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No

    5. Study Description

    Brief Summary
    To compare the efficacy of local injections of two different types of steroid (betamethasone suspension versus triamcinolone acetate) in management of patients with thyroid-related upper lid retraction either isolated or associated with proptosis.
    Detailed Description
    Thyroid Eye Disease (TED) is a complex autoimmune disorder that causes substantial morbidity. It can result in enlargement and scarring of orbital fat and muscles with orbital disfigurement, diplopia, and even vision loss. Although the disease is self-limited following an inflammatory phase of 12 - 18 months, its long-term changes to periocular tissues may have a significant effect on the quality of life, mental health, and socioeconomic status of patients. Most patients with TED (>90%) have Graves' disease, which is an inflammatory autoimmune condition that is caused by thyrotropin (TSH) receptor autoantibodies. Graves' disease is common around the world and it mainly affects middle-aged women with an overall prevalence of 0.5%. Several validated assessment scores are used to assess different components of the disease. The two main current TED classifications are from the European Group on Graves Orbitopathy (EUGOGO); and Vision, Inflammation, Strabismus, Appearance (VISA). EUGOGO has introduced one score for clinical activity (CAS) and one for severity "Clinical Severity Score" (CSS). The baseline CAS asses 7 subjective symptoms and inflammatory signs with 3 additional points in follow-up for increased proptosis, decreased ocular motility, or decreased visual acuity (the CAS 10- point scale). In comparison, CSS evaluates the magnitude of the exophthalmometer or proptosis values, lid retraction, diplopia grades, and corneal involvement. Periorbital inflammation can cause swelling, fatty infiltration, and scarring of the eyelid muscles, resulting in eyelid retraction and upper scleral exposure, which are the most common clinical features of TED. Several treatment options have been described for correction of eyelid retraction (ELR), including local steroid, Botox and filler injection, and surgeries in the fibrotic stage. Although surgical treatment remains an effective option, the outcomes may be unpredictable. In addition, there are some situations where surgery is inappropriate or contraindicated, where temporary or definitive measures are required during the active phase of the disease, or where patients may prefer less invasive options. Systemic steroid therapy is a well-established form of immunosuppressive treatment for TED. There have been reports showing promising results with local steroid injection for the treatment of upper eyelid retraction (UER), There are also some reports about the retrobulbar and periocular injection of steroids for management of proptosis in TED.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Thyroid Eye Disease

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 4
    Interventional Study Model
    Parallel Assignment
    Masking
    Participant
    Allocation
    Randomized
    Enrollment
    64 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    A1 peri-levator betamethasone injection
    Arm Type
    Experimental
    Arm Description
    patients with isolated thyroid-related upper lid retraction who will be given the Peri-levator injection of betamethasone suspension
    Arm Title
    A2 Peri-levator triamcinolone acetate injection
    Arm Type
    Experimental
    Arm Description
    patients with isolated thyroid-related upper lid retraction who will be given Peri-levator injection of triamcinolone acetate
    Arm Title
    B1 Peri-levator and retrobulbar betamethasone injection
    Arm Type
    Experimental
    Arm Description
    patients with thyroid-related upper lid retraction and proptosis who will be given Peri-levator and retrobulbar injection of betamethasone suspension
    Arm Title
    B2 Peri-levator and retrobulbar triamcinolone acetate injection
    Arm Type
    Experimental
    Arm Description
    patients with thyroid-related upper lid retraction and proptosis who will be given Peri-levator and retrobulbar injection of triamcinolone acetate
    Intervention Type
    Procedure
    Intervention Name(s)
    peri-levator betamethasone injection
    Intervention Description
    The injection dose will be 1.5 ml of betamethasone suspension (1 ml contains 5 mg betamethasone dipropionate &2 mg betamethasone sodium phosphate). The needle will be introduced percutaneously superior to the globe and advanced towards the orbital roof to a depth of approximately 15 mm where the injection is delivered. The injection will be repeated every 4-6 weeks according to the clinical response up to 3 injections.
    Intervention Type
    Procedure
    Intervention Name(s)
    peri-levator triamcinolone injection
    Intervention Description
    The needle will be introduced percutaneously superior to the globe and advanced towards the orbital roof to a depth of approximately 15 mm where 1ml (40mg/ml) triamcinolone acetate is injected. The injection will be repeated every 4-6 weeks according to the clinical response up to 3 injections.
    Intervention Type
    Procedure
    Intervention Name(s)
    peri-levator and retrobulbar betamethasone injection
    Intervention Description
    In addition to peri-levator betamethasone injection for UER, a retrobulbar injection for proptosis will be given with the needle introduced through the skin of the lateral one-third of the lower eyelid and passed posteriorly, medially, and upward to reach the retrobulbar space.
    Intervention Type
    Procedure
    Intervention Name(s)
    peri-levator and retrobulbar triamcinolone injection
    Intervention Description
    In addition to peri-levator triamcinolone injection for UER, a retrobulbar injection for proptosis will be given with the needle introduced through the skin of the lateral one-third of the lower eyelid and passed posteriorly, medially, and upward to reach the retrobulbar space.
    Primary Outcome Measure Information:
    Title
    to measure the change in MRD1 in mm using a ruler in all groups after peri-levator injection of different types of steroid
    Description
    The technique will be considered; 1) Effective if the MRD1 reaches the normal value< or= 4mm, 2) Partially effective if the MRD1 is improved but do not reach the normal values, 3) Ineffective if no improvement occur in MRD1
    Time Frame
    2 minutes
    Title
    to measure the change in proptosis in mm using Hertel's exophthalmometer in group B after retrobulbar injection of different types of steroid
    Description
    The technique will be considered; 1) Effective if the reading of Hertel's exophthalmometer reaches the normal value (16±2mm), 2) Partially effective if the proptosis is improved but do not reach the normal values, 3) Ineffective of no improvement occur in proptosis
    Time Frame
    4 minutes
    Secondary Outcome Measure Information:
    Title
    to document any change in size of superior rectus levator complex and other extra-ocular muscles
    Description
    measuring size of superior rectus levator complex and other extra-ocular muscles before and after injections by orbital imaging techniques (CT or MRI).
    Time Frame
    4 minutes

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Clinical diagnosis of Thyroid Eye Disease. Thyroid function within normal range. Exclusion Criteria: Patients on systemic steroid and or immunosuppressive therapy. Patients underwent thyroidectomy. Sight threatening (severe) TED which requires immediate surgery. Patients with fibrotic ocular muscles who need surgery. Contraindications to steroid therapy as in pregnant women.
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Rawda Abdelnasser, MD
    Phone
    00201008053325
    Email
    rawda878@gmail.com
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Ahmed Abdelal, MD
    Organizational Affiliation
    Assiut University
    Official's Role
    Study Chair
    First Name & Middle Initial & Last Name & Degree
    Mohamed Shehata, MD
    Organizational Affiliation
    Assiut University
    Official's Role
    Study Director
    First Name & Middle Initial & Last Name & Degree
    Salma Kedwany, MD
    Organizational Affiliation
    Assiut University
    Official's Role
    Study Director

    12. IPD Sharing Statement

    Citations:
    PubMed Identifier
    27038492
    Citation
    De Leo S, Lee SY, Braverman LE. Hyperthyroidism. Lancet. 2016 Aug 27;388(10047):906-918. doi: 10.1016/S0140-6736(16)00278-6. Epub 2016 Mar 30.
    Results Reference
    background
    PubMed Identifier
    29569622
    Citation
    Taylor PN, Albrecht D, Scholz A, Gutierrez-Buey G, Lazarus JH, Dayan CM, Okosieme OE. Global epidemiology of hyperthyroidism and hypothyroidism. Nat Rev Endocrinol. 2018 May;14(5):301-316. doi: 10.1038/nrendo.2018.18. Epub 2018 Mar 23.
    Results Reference
    background
    PubMed Identifier
    27099835
    Citation
    Bartalena L, Baldeschi L, Boboridis K, Eckstein A, Kahaly GJ, Marcocci C, Perros P, Salvi M, Wiersinga WM; European Group on Graves' Orbitopathy (EUGOGO). The 2016 European Thyroid Association/European Group on Graves' Orbitopathy Guidelines for the Management of Graves' Orbitopathy. Eur Thyroid J. 2016 Mar;5(1):9-26. doi: 10.1159/000443828. Epub 2016 Mar 2.
    Results Reference
    background
    PubMed Identifier
    21730842
    Citation
    Kazim M, Gold KG. A review of surgical techniques to correct upper eyelid retraction associated with thyroid eye disease. Curr Opin Ophthalmol. 2011 Sep;22(5):391-3. doi: 10.1097/ICU.0b013e3283499433.
    Results Reference
    background
    PubMed Identifier
    22333849
    Citation
    Xu D, Liu Y, Xu H, Li H. Repeated triamcinolone acetonide injection in the treatment of upper-lid retraction in patients with thyroid-associated ophthalmopathy. Can J Ophthalmol. 2012 Feb;47(1):34-41. doi: 10.1016/j.jcjo.2011.12.005.
    Results Reference
    background
    PubMed Identifier
    25673253
    Citation
    Hamed-Azzam S, Mukari A, Feldman I, Saliba W, Jabaly-Habib H, Briscoe D. Fornix triamcinolone injection for thyroid orbitopathy. Graefes Arch Clin Exp Ophthalmol. 2015 May;253(5):811-6. doi: 10.1007/s00417-015-2957-7. Epub 2015 Feb 12.
    Results Reference
    background
    PubMed Identifier
    28248444
    Citation
    Joos ZP, Sullivan TJ. Peri-levator palpebrae superioris triamcinolone injection for the treatment of thyroid eye disease-associated upper eyelid retraction. Clin Exp Ophthalmol. 2017 Aug;45(6):651-652. doi: 10.1111/ceo.12939. Epub 2017 Mar 28. No abstract available.
    Results Reference
    background
    PubMed Identifier
    15962642
    Citation
    Poonyathalang A, Preechawat P, Charoenkul W, Tangtrakul P. Retrobulbar injection of triamcinolone in thyroid associated orbitopathy. J Med Assoc Thai. 2005 Mar;88(3):345-9.
    Results Reference
    background
    PubMed Identifier
    32095211
    Citation
    Bagheri A, Abbaszadeh M, Yazdani S. Intraorbital Steroid Injection for Active Thyroid Ophthalmopathy. J Ophthalmic Vis Res. 2020 Feb 2;15(1):69-77. doi: 10.18502/jovr.v15i1.5948. eCollection 2020 Jan-Mar.
    Results Reference
    background
    PubMed Identifier
    32782513
    Citation
    Wang Y, Du B, Yang M, Zhu Y, He W. Peribulbar injection of glucocorticoids for thyroid-associated ophthalmopathy and factors affecting therapeutic effectiveness: A retrospective cohort study of 386 cases. Exp Ther Med. 2020 Sep;20(3):2031-2038. doi: 10.3892/etm.2020.8896. Epub 2020 Jun 17.
    Results Reference
    background
    PubMed Identifier
    27797318
    Citation
    Smith TJ, Hegedus L. Graves' Disease. N Engl J Med. 2016 Oct 20;375(16):1552-1565. doi: 10.1056/NEJMra1510030. No abstract available.
    Results Reference
    result

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    Local Betamethasone Versus Triamcinolone Injection in Management of Thyroid Eye Disease

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