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  • Early Response Seen With Teprotumumab for TED Appears to Wane in the Long Term

    Oculoplastics/Orbit

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    Review of: Reactivation after teprotumumab treatment for active thyroid eye disease

    Hwang C, Rebollo N, Mechels K, et al. American Journal of Ophthalmology, July 2024

    Investigators studied the long-term proptosis reactivation/recurrence rate in patients who had completed a full course of teprotumumab treatment for active thyroid eye disease (TED).

    Study Design

    This was a retrospective review of records from 21 patients with active TED treated at Cole Eye Institute/Cleveland Clinic. Three patients received 7 infusions of teprotumumab rather than the usual 8 infusions. Clinical Activity Score (CAS), Hertel exophthalmometry measurements, margin reflex distance, and diplopia were recorded at each visit. Patients were followed for at least 6 months after completion of teprotumumab therapy.

    Outcomes

    Seventeen patients had early proptosis response, defined as a proptosis reduction of ≥2 mm in either eye. Of this group, 10 patients (58.8%) had proptosis recurrence. Twenty patients had early response as measured by CAS criteria, but 11 eventually regressed (i.e., CAS score worsened by ≥2 points). Eight patients had both CAS and proptosis criteria regression. Overall, the average time to recurrence was 12.25 months.

    Limitations

    The study population was relatively small and heterogeneous. In addition, the patients received variable treatment prior to the institution of teprotumumab therapy, which may have affected the response to teprotumumab.

    Clinical Significance

    In many of the teprotumumab studies published to date, the durability of the response has been unclear. This study focused specifically on durability and found that there was a significant lack of durability with time. While a significant early response to teprotumumab was noted, at 12 months post-treatment only 57% of patients maintained a response; beyond 12 months, there appeared to be a 33% response rate. The authors considered these findings to be clinically valid. Patients who are considering treatment with teprotumumab should be counseled that the initial positive effect of teprotumumab can diminish with time. This is especially important considering the high costs of treatment and the potential for significant side effects.

    Financial Disclosures: Dr. Richard Allen discloses no financial relationships.