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  • Frequency of Hearing Deficits With Teprotumumab

    By Lynda Seminara
    Selected by Russell N. Van Gelder, MD, PhD
    Comprehensive Ophthalmology
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    Journal Highlights

    Ophthalmology, January 2024

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    Teprotumumab can be beneficial for managing thyroid eye disease, but there have been subjective and objective reports of audiologic dysfunction during its use. Keen et al. reviewed the hearing-related symptoms and audiometry findings of patients treated with intravenous teprotumumab. Among their study of 44 ears, significant hearing loss occurred in more than one-third; 50% of the patients experienced ototoxicity.

    The study participants were adults who received teprotumumab infusions for thyroid eye disease at a single academic institution. The 22 patients underwent audio­metric testing before starting teprotumumab and after their final infusion. Documented data included age, sex, and otologic symptoms. The standard treatment protocol was followed for most patients, and each ear was evaluated separately. The main outcome measure was hearing loss, defined as 1) a significant change in decibel hearing threshold or 2) meeting the criteria for ototoxicity.

    Nineteen (86%) of the 22 patients were women. Age at the time of first infusion ranged from 31 to 73 years (mean, 52.4 years). Twenty patients received all eight infusions per the protocol. The two patients who received fewer infusions (two or five treatments) were included in the analysis. Overall, 62 audiograms were analyzed: 22 from baseline (0-84 days before treatment), 18 during treatment, and 22 after treat­ment. By 496 days posttreatment, ototoxicity had occurred in 17 ears (39%). Eleven (50%) of the 22 patients had ototoxicity in at least one ear. The pure-tone average decibel hearing levels of the 44 ears demonstrated that posttreatment hearing loss occurred at high (p = .0008) and middle (p = .0042) frequencies but not at low frequencies (p = .8344).

    These data suggest that teprotumu­mab negatively affects hearing, said the authors. Before starting treatment, patients should be informed of these possible effects. The authors emphasized the need to establish a protocol for monitoring hearing during teprotumumab treatment so that any changes can be addressed promptly. “Collaboration with audiologists and otolaryngologists will help to guide the interpretation of audiometry results and management of hearing changes,” they said.

    The original article can be found here.