Comparison of Block and Replace Regime and Titration Regime in Graves’ Disease

In Graves’ disease (GD), medical treatment is still the cornerstone in its management and there were some studies done on comparison of the block and replace regime and titration regime of the antithyroid drugs (ATDs). In Myanmar, titration regime is mostly practiced for management of GD. In daily clinical practice, frequent hospital visits are needed in titration regime and loss of follow-up is an obstacle in patients treated with titration regime. A hospital based randomized clinical trial was conducted and aimed to compare the proportion of attainment of euthyroid status between block and replace regime and titration regime in patients with recently diagnosed GD. A total of 117 patients; 58 patients in block and replace regime and 59 patients in titration regime, who met the inclusion criteria were included. The results showed that euthyroid status was observed in increasing trend during the study period for both regimes but there was no significant difference of achieving euthyroid status between the regimes at the end of 12 months. Regarding side effects of ATDs, skin rash and pruritus were more frequently occurred during the first 3 months of ATDs but no significant difference was noted between the regimes at the end of study. There was also no case of serious side effects such as agranulocytosis and hepatotoxicity up to the end of 12 months. The results of the study pointed out that block and replace regime was comparable to dose titration regime in attaining euthyroid status. As a conclusion, block and replace regime can be applied as an alternative option where titration regime is not feasible. Reference: (1) Abraham et al., 2005; A systematic review of drug therapy for Graves’ hyperthyroidism. Eur J Endocrinol. 153: 489-98. (2) Vaidya et al., 2014; Block & replace regime versus titration regime of antithyroid drugs for the treatment of Graves’ disease: a retrospective observational study. Clinical Endocrinology. 81: 610–613.