Efficacy and Safety of Teprotumumab in Thyroid Eye Disease

Abstract

Honeylen Maryl Teo,1 Terry J Smith,2,3 Shannon S Joseph2 1Eye Institute, St. Luke’s Medical Center, Metro Manila, Philippines; 2Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI, USA; 3Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USACorrespondence: Shannon S Joseph 1000 Wall Street, Ann Arbor, MI, 48105, USATel +1-734-936-9503Email [email protected]: Thyroid eye disease (TED; also known as thyroid-associated ophthalmopathy) is an autoimmune condition with disabling and disfiguring consequences. Teprotumumab is the first and only medication approved by the United States Food and Drug Administration for the treatment of TED. We review the efficacy and safety of teprotumumab in TED, highlighting results from the 2 randomized, double-masked, placebo-controlled trials. Post-approval case reports of teprotumumab use in patients with compressive optic neuropathy (CON) and inactive TED were similarly favorable to those from the trials. The preliminarily results of teprotumumab for CON and inactive TED should be investigated in formal clinical trials. Teprotumumab should be avoided in pregnancy. Evidence also suggests that teprotumumab may exacerbate pre-existing inflammatory bowel disease, worsen hyperglycemia, and be associated with hearing impairment. Patients at risk for these adverse events need to be closely monitored with baseline and periodic assessments.Keywords: monoclonal antibody, anti-IGF-IR, thyroid-associated ophthalmopathy, Graves’ ophthalmopathy, autoimmune

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