The relation between clinical response and quality of life improvement after treatment with intravenous methylprednisolone in Graves' orbitopathy

BACKGROUND: Quality of life (QoL) is a key outcome in Graves' orbitopathy (GO), but prior studies have reported overall QoL changes without evaluating whether improvements occur specifically in patients who achieve objective clinical response. Thus, it remains unclear to what extent clinical response translates into improved QoL, or whether treatment failure adversely affects well-being. METHODS: In this prospective study, 40 patients with moderate-to-severe active GO were assessed at baseline and 12 and 24 weeks after initiation of intravenous methylprednisolone (IVMP). Clinical response was assessed based on clinical activity score (CAS) improvement. QoL was evaluated using GO-QOL (function and appearance) and TED-QOL (overall, function and appearance) questionnaires. RESULTS: At 24 weeks, GO-QOL function declined in non-responders but not in responders. However, this difference was no longer significant after adjustment for confounders. For TED-QOL overall and function domains, treatment response at 12 weeks remained an independent predictor of QoL improvement after adjustment. Additionally, responders demonstrated a more favourable QoL trajectory during the first 12 weeks. Clinically meaningful improvement in all TED-QOL domains was more frequent in responders at 12 weeks, whereas deterioration in TED-QOL overall and function domains was more common in non-responders. No such pattern was observed for GO-QOL. TED-QOL, but not GO-QOL, demonstrated fair to moderate agreement between clinical response and clinically meaningful improvement at 12 weeks. CONCLUSIONS: Clinical response to IVMP is associated with substantial short-term gains in TED-QOL, whereas non-responders face a higher risk of QoL decline. In contrast, GO-QOL does not reflect clinical response.