Efficacy and safety of mycophenolate mofetil in the treatment of moderate to severe Graves’ orbitopathy: a meta-analysis

Figures & data

Figure 1. Flow diagram of study selection.

Table 1. Baseline characteristics of eligible clinical trials.

Study	Location	Patients (n)	Age (years)	Sex (M/F)	Disease severity	Course of the disease	Intervention	Control
Wang 2003	China	51	21–54	24/27	NOSPECS ≥2 levels	1–12 months	MMF/PO, 1 g/day for 12 weeks (12)	Prednisone/PO, 40 mg/day for 4 weeks 20 mg/day for 4 weeks; 10 mg/day for 4 weeks (13)
Zhang 2011	China	70	21–63	48/22	NOSPECS ≥2 levels	MMF: 6–32 months; MP: 1–15 months	MMF/PO, 1.5 g/day for 8 weeks; 0.5–0.75 g/day for 3–6 months (meanwhile, prednisone/PO, 1 mg/kg/day, reduce to a maintenance level, last for 3–6 months (35)	MP/IVD, 0.5 g/day * 3 days/week for 4 weeks Prednisone/PO, 1 mg/kg/day, reduce to a maintenance level, last for 3–6 months (35)
Cui 2013	China	115	Dec-70	38/77	NOSPECS ≥2 levels	1 week–20 years	MMF/PO, 1 g/day for 12 weeks (40)	Prednisone/PO, 40 mg/day for 4 weeks 20 mg/day for 4 weeks; 10 mg/day for 4 weeks (30)
Hu 2015	China	40	25–45	18/22	NOSPECS ≥2 levels; CAS ≥3 scores (3–7)	No	MMF/PO, 1 g/day for 12 weeks (22)	Prednisone/PO, 40 mg/day for 4 weeks 20 mg/day for 4 weeks; 10 mg/day for 4 weeks(18)
Ye 2017	China	158	16–70	52/106	Moderate-to-severe; CAS ≥4 scores (4–10)	MMF: 5.84 ± 3.71 months GC: 6.37 ± 5.89 months	MMF/PO, 1 g/day for 24 weeks (80)	MP/IVD, 0.5 g/day * 3 day/week for 2 weeks; Prednisone/PO, 60 mg/day * 8 weeks a reduction of 5 mg per week for 14 weeks (78)
Kahaly 2018	Germany, Italy	164	18–75	39/125	Moderate-to-severe; CAS ≥3 scores (3–7)	MP + MMF: 5–19.5 months MP: 4–18 months	MP/IVD, 0.5 g/week for 6 weeks; 0.25 g/week for 6 weeks. MMF/PO, 0.72 g/day for 24 weeks(75)	MP/IVD, 0.5 g/week for 6 weeks 0.25 g/week for 6 weeks (72)

Abbreviations: MMF = mycophenolate mofetil; PO = per os; MP = methylprednisolone; IVD = intravenous drip; GC = glucocorticoid; CAS = clinical activity score; wks = weeks

Figure 2. Risk of bias of included studies.

Figure 3. Funnel plot for the response of MMF (with or without GC) versus GC. MMF: mycophenolate mofetil; GC: glucocorticoid.

Figure 4. Sensitivity analysis for the response of MMF (with or without GC) versus GC. MMF: mycophenolate mofetil; GC: glucocorticoid.

Figure 5. Forest plot for the response of MMF (with or without GC) versus GC. MMF: mycophenolate mofetil; GC: glucocorticoid.

Figure 6. Forest plot for CAS change of MMF (with or without GC) versus GC. CAS: clinical activity score; MMF: mycophenolate mofetil; GC: glucocorticoid.

Figure 7. Forest plot for the incidence of AE of MMF (with or without GC) versus GC. AE: adverse event; MMF: mycophenolate mofetil; GC: glucocorticoid.

Data availability statement

All data are provided in this article, and data processing methods can be obtained from corresponding author upon reasonable request.