Evidence map›Paper›PMID 41743555›Full record

SynthesisFrontiers in endocrinology2026

Immunomodulators in Graves' ophthalmopathy: a systematic review.

Antoinette Yeung, Mohammed Saqlain Siddiqui, Neginsadat Mirtorabi, Umnia Nasir Ahmed, Emma Watts, Neil Sharma, Reena Kumari, Kristien Boelaert, Jameel Muzaffar, Hannah Nieto

Abstract readSystematic Review
In one paragraph

Synthesis in Frontiers in endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Antoinette Yeung *Ear, Nose and Throat Surgery, University Hospitals Birmingham National Health Service (NHS) Foundation Trust, Birmingham, United Kingdom.
Mohammed Saqlain Siddiqui *National Health Service, University of Birmingham Medical School, Birmingham, United Kingdom.
Neginsadat MirtorabiEar, Nose and Throat Surgery, University Hospitals Birmingham National Health Service (NHS) Foundation Trust, Birmingham, United Kingdom.
Umnia Nasir AhmedNational Health Service, University of Birmingham Medical School, Birmingham, United Kingdom.
Emma WattsEar, Nose and Throat Surgery, University Hospitals Birmingham National Health Service (NHS) Foundation Trust, Birmingham, United Kingdom.
Neil SharmaEar, Nose and Throat Surgery, University Hospitals Birmingham National Health Service (NHS) Foundation Trust, Birmingham, United Kingdom.
Reena KumariOphthalmology, University Hospitals Birmingham National Health Service (NHS) Foundation Trust, Birmingham, United Kingdom.
Kristien BoelaertDepartment of Applied Health Sciences, University of Birmingham, Birmingham, United Kingdom.
Jameel Muzaffar *Ear, Nose and Throat Surgery, University Hospitals Birmingham National Health Service (NHS) Foundation Trust, Birmingham, United Kingdom.
Hannah Nieto *Department of Metabolism and Systems Science, University of Birmingham, Birmingham, United Kingdom.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Graves' Ophthalmopathy (GO), or thyroid eye disease, is an extrathyroidal complication of Graves' disease, causing a significant impact on patients' quality of life. There are consensus statements from both the American Thyroid Association (ATA) and the European Group on Graves' Orbitopathy (EUGOGO) which provide guidance in management. However, there remain areas of ongoing debate and evolution in treatment approaches. This systematic review aims to evaluate immunomodulatory drugs in the treatment of GO. Methods: The following databases were searched: Cochrane (CENTRAL), Embase, MEDLINE, ProQuest, PubMed, SCOPUS, and Web of Science. The last date of searching for each database was 10th October 2025. All primary studies on human patients with GO, treated with newer, targeted immunomodulatory therapies, in particular biologics and/or disease-modifying antirheumatic drugs, were included. Studies in languages other than English were excluded. The primary outcome of interest was Clinical Activity Score (CAS). A narrative synthesis was performed, including CAS and four other secondary outcomes. Cochrane risk of bias tools were used to assess quality of evidence. The study is registered on PROSPERO (CRD42023400285). Results: Of 4839 records identified, 41 were eligible for data extraction. Teprotumumab and tocilizumab showed benefit in reducing CAS and proptosis, whilst rituximab was inconclusive. Methotrexate and reduced-dose steroids were beneficial in reducing CAS, and both methotrexate and cyclosporine with steroids were good for reducing proptosis. However, effects of immunomodulation on other secondary outcomes were unclear. Adverse events were higher in the steroid treated patients compared to all other drugs. Conclusion: Biologics and steroid-sparing agents may be more effective than steroids at reducing CAS, but this is limited by the lack of head-to-head comparisons between drugs and significant heterogeneity amongst the included studies. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023400285.

Indexed as

clinical activity scoreGravesimmunomodulatorsophthalmopathyorbitopathyproptosis

Identifiers

PMID41743555
PMCPMC12929135

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.