Efficacy and safety of intravenous versus oral corticosteroid therapy in Graves’ ophthalmopathy: a systematic review and meta-analysis of randomized controlled trials

Purpose: Graves’ ophthalmopathy (GO) is an autoimmune orbital inflammatory disease associated with Graves’ disease. It can cause vision loss, facial disfigurement, and reduced quality of life. Systemic corticosteroids remain the first-line treatment for moderate-to-severe GO, administered either orally or intravenously. However, the optimal route of administration remains uncertain, with ongoing debate regarding their comparative efficacy and safety. The aim of this review is to compare the efficacy and safety of intravenous versus oral corticosteroids in the treatment of moderate-to-severe GO. Methods: Randomized controlled trials were included. Risk of bias was assessed using the Cochrane RoB 2 tool. Outcomes focused on efficacy and safety of intravenous versus oral glucocorticoids in the treatment of GO. Results: Five eligible RCTs involving 288 patients were analyzed. Intravenous steroids appeared to improve the clinical activity score (MD = −0.57; 95% CI: −0.82 to −0.33; p < 0.00001) and reduce the risk of Cushingoid facial features (RR = 0.17; 95% CI: 0.08 to 0.35; p < 0.00001). However, limited efficacy was observed in diplopia, proptosis, and in minimizing other steroid-related adverse events. Conclusion: IV steroids were associated with more favourable outcomes and better tolerability than oral steroids in moderate-to-severe GO. Further comprehensive trials are needed to confirm long-term safety and optimize treatment protocols.