Combined immunosuppressants and less steroids in active graves' orbitopathy?

Steroid therapy in GO is first-line treatment but has limitations, as it is potentially harmful at high doses and often refused by patients. A steroid-sparing therapy is a reasonable option as long as it is rapidly effective and devoid of long-term adverse reactions. Combined immunosuppressive therapy must be studied in randomized clinical trials designed to test efficacy and the potentially increased risk of side effects.