Study findings presented at the American Society of Ophthalmic Plastic & Reconstructive Surgery's 2021 Fall Scientific Symposium detail the benefits of teprotumumab for thyroid eye disease.
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:
“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].”
A separate study2 presented at the meeting explored the effects of teprotumumab on volume of lacrimal glands and tear production. Dry eye syndrome is a common cause of discomfort among individuals with thyroid eye disease and can occur in up to 85% of patients, investigators explained, while eyelid manipulation plays an important role in disrupting the ability of the eyelids to protect the ocular surface.
“Recent work has shown that mechanical factors, such as upper eyelid retraction, interpalpebral fissure distance, or proptosis, were not predictive of the development of [dry eye syndrome] in patients with chronic [thyroid eye disease]. Enlargement of the lacrimal gland in [thyroid eye disease] has been found to correlate with subjective tearing,” they added.
The prospective longitudinal study enrolled individuals with thyroid eye disease and excluded those who were currently on treatment for the condition or received rituximab or tocilizumab in the past. In addition to change in volume of the lacrimal gland and production of tears after treatment with teprotumumab, the researchers also measured eyelid positions including margin-to-reflex distance (MRD), change in proptosis, and change in CAS.
Twenty individuals were enrolled in the study, with a mean age of 52 and mean (SD) duration of thyroid eye disease of 30 (35) months prior to therapy initiation. All patients completed 8 infusions of teprotumumab.
“Tear secretion was measured by the Schirmer test in each eye for 5 minutes. The orbit with the worse proptosis was designated as the study orbit,” authors wrote.
Analyses showed:
Overall, the study revealed teprotumumab significantly reduced thyroid eye disease–related expansion of the lacrimal gland and increased tear production, while these changes were significant in patients with acute and chronic thyroid eye disease, the researchers concluded.
One additional study presented at the conference3 focused on reversal of Graves’ disease–associated facial volume expansion and eyelid changes in patients after they underwent teprotumumab treatment.
As thyroid eye disease can cause orbital soft tissue expansion and could result in brow and temple changes, researchers investigated changes to pan-facial soft tissue volumes and eyelid position among those who received teprotumumab.
Patients presenting to an institution for treatment for thyroid eye disease (n = 43) were included in the prospective study. However, those currently receiving treatment for the condition and “who had any plans to embark on a weight loss regimen or begin medications that may result in weight loss were excluded.”
Changes in tissue volume were assessed at baseline and 3 weeks after patients’ last infusion with teprotumumab. The mean duration of thyroid eye disease was 30 (34) months.
Measurements showed that following therapy, “mean decrease in volume for each region was 0.74 (0.82) mL in the upper face, 1.9 (1.2) mL in the periorbital region, 0.18 (0.6) mL in the temples, 1.73 (2.2) mL in the midface, and 2.84 (4.7) mL in the lower face.”
Furthermore, there was a mean decrease in volume of the full face 8.4 (8.5) mL and a significant reduction in MRD1, MRD2, and the intercanthal distance following treatment. “The contours of both upper and lower eyelids changed significantly following therapy (P < .05). Mean weight was 75 (12) kg prior to therapy and 69 (15) kg following therapy (P < .05),” the authors added.
No relationship was found between previous steroid use and reductions in total body weight or changes in facial volume among participants.
Despite the relatively small number of patients included in the study, the findings suggest thyroid eye disease sequalae “may affect soft tissues beyond the orbit and periorbita and may result in changes across the entire face,” while teprotumumab can significantly reduce these changes, in addition to eyelid retraction.
References
The Push for Fair Pricing and Reform in Pharmacy Benefit Management
April 3rd 2025Amid growing legislative pressures and industry debates, pharmacy benefit managers (PBMs) are exploring new strategies to enhance transparency, reduce patient costs, and navigate the evolving healthcare landscape.
Read More
The Importance of Examining and Preventing Atrial Fibrillation
August 29th 2023At this year’s American Society for Preventive Cardiology Congress on CVD Prevention, Emelia J. Benjamin, MD, ScM, delivered the Honorary Fellow Award Lecture, “The Imperative to Focus on the Prevention of Atrial Fibrillation,” as the recipient of this year’s Honorary Fellow of the American Society for Preventive Cardiology award.
Listen
Using AI-Driven Strategies to Optimize Specialty Drug Costs, Manage Polypharmacy
April 2nd 2025As health care costs continue to rise, artificial intelligence (AI)-driven solutions are emerging as a powerful tool for managing specialty drug spending and polypharmacy risks, as showcased in recent research presented at the Academy of Managed Care Pharmacy 2025 conference.
Read More
Promoting Equity in Public Health: Policy, Investment, and Community Engagement Solutions
June 28th 2022On this episode of Managed Care Cast, we speak with Georges C. Benjamin, MD, executive director of the American Public Health Association, on the core takeaways of his keynote session at AHIP 2022 on public health policy and other solutions to promote equitable health and well-being.
Listen
How Recent Federal Policy Changes Are Shaping Managed Care Pharmacy
April 2nd 2025Federal legislative and regulatory changes are reshaping pharmacy practice, with key challenges in government funding, pharmacy benefit manager reform, and health care policy shifts—topics explored by experts at the Academy of Managed Care Pharmacy's annual meeting.
Read More
The IRA’s Unintended Consequences for Drug Pricing and Coverage
April 2nd 2025The Inflation Reduction Act (IRA) may be restricting Medicare Part D formularies, increasing patient costs, and stifling pharmaceutical innovation, experts warned at the Academy of Managed Care Pharmacy 2025 annual meeting.
Read More