Eight RCTs were included in the review (376 patients). Allocation concealment methods were adequate in six trials and unclear in two. Participants were blinded in one trial, examiners were blinded in five trials, but none of the trials blinded trial investigators. Withdrawals rates ranged from 0 to 7%. The mean quality score was 3.1.
Intravenous glucocorticoids showed statistically significantly higher effective rates compared with placebo (RR 7.5, 95% CI 1.1 to 49.3; one RCT) and oral glucocorticoids (RR 1.48, 95% CI 1.18 to 1.86; three RCTs; Ι²=0%). Intravenous glucocorticoids also significantly reduced clinical activity score compared with oral glucocorticoids (WMD 0.86, 95% CI 0.53 to 1.18; three RCTs; Ι²=0%).
The combination of intravenous glucocorticoids and orbital radiotherapy resulted in significantly higher effective rates (RR 1.40, 95% CI 1.11 to 1.77; two RCTs; Ι²=0%) than combined oral glucocorticoids and orbital radiotherapy. Combined intravenous glucocorticoids and orbital radiotherapy significantly also reduced clinical activity score (WMD 0.66, 95% CI 0.30 to 1.02; two RCTs; Ι²=0%). Five trials reported on proptosis with no significant differences found between any treatments.
For adverse effects, statistically significantly higher rates were found in the oral group when compared with the intravenous group for Cushingoid features (RR 0.21, 95% CI 0.12 to 0.38; three RCTs) and weight gain (RR 0.21, 95% CI 0.06 to 0.68; two RCTs) but not for palpitations, myalgia, hypertension, sleepiness, depression, gastrointestinal effects, and hyperglycaemia.