Recalcitrant TED Responsive to Teprotumumab

New research presented at the American Society of Ophthalmic Plastic & Reconstructive Surgery’s fall symposium highlighted the benefits of Tepezza (teprotumumab) for patients with thyroid eye and Graves disease.

Teprotumumab, a biologic, is the only FDA-approved treatment for thyroid eye disease. It is a targeted inhibitor of the insulin-like growth factor-1 receptor that is administered to patients once every 3 weeks for a total of 8 infusions.

In a multicenter retrospective study,¹ researchers sought information on teprotumumab’s efficacy in patients with previous orbital irradiation, surgery, glucocorticoid use (cumulative dose > 1 g), or prior biologic treatment, as these individuals were excluded from initial clinical trials.

Only individuals who received at least 4 infusions were included in the analysis (N = 52) while treatment failure was defined as “an incomplete response to previous treatment or recurrent active disease.”

Outcomes measured included clinical activity score (CAS), proptosis mean reduction and Gormon diplopia score (GDS), thyroid stimulating immunoglobulin, and Graves’ ophthalmopathy quality of life questionnaire (GO-QOL) scores.

The majority of patients assessed were female (n 42) and the average patient age was 56.3 years. In addition, mean patient follow-up time was 29.6 weeks.

Analyses revealed:

• Mean reductions after 2 infusions: CAS of 2.8 (P < .001), proptosis of 2.6 mm (P < .001); GO-QOL increased an average of 38 points (P = .004)
• Mean reductions after an average of 5 infusions: CAS of 3.6 (P < .001), proptosis of 4 mm (P < .001), and 61% of patients with baseline diplopia experienced a 1-point or better improvement in GDS
• GO-QOL improved by 23 points (P = .029) overall

“The patients in this cohort demonstrated a significant improvement in each of the primary study outcomes,” the researchers concluded. “These results indicate that [thyroid eye disease] recalcitrant to conventional therapies is responsive to teprotumumab and should be considered for the treatment of recalcitrant [thyroid eye disease].”