Effect of teprotumumab on intraocular pressure in thyroid-associated ophthalmopathy

Abstract

Purpose : Thyroid eye disease (TED) is a progressive, debilitating and potentially blinding autoimmune disease. Teprotumumab, a novel human monoclonal antibody, reduces orbital soft tissue volume and improves the clinical manifestations of TED, however, the effects on intraocular pressure (IOP) remain uncharacterized. We conducted a retrospective chart review to investigate changes in IOP in patients with TED following teprotumumab treatment.

Methods : A single-center retrospective review of TED patients treated with teprotumumab at the Scheie Eye Institute was conducted. Exclusion criteria included prior surgical treatment for TED and follow-up duration less than 3 weeks. Data was collected on baseline IOP, IOP post-treatment, clinical activity score, proptosis, and treatment duration. IOP was measured using a rebound tonometer in primary gaze. The main outcome measure was change in IOP at week 12 of treatment. Mean differences in IOP following treatment were estimated by modeling the effect of time on IOP using generalized estimating equations. Associations between IOP measurements, proptosis and clinical activity score were established using linear regression that accounted for inter-eye correlation by generalized estimating equations.

Results : 12 TED patients treated with teprotumumab were included. Mean age was 50.8 years (range 34-74); 92% of patients were female (Table 1). Average treatment duration was 13 weeks (range 6-24), average baseline IOP was 19.8 mm Hg (range 13-28) and average baseline clinical activity score was 3.6 (range 0-6). 24 eyes were examined at baseline, 10 at 6 weeks and 20 at 12 weeks. Mean IOP was decreased at 12 weeks of treatment (mean change = -2.8 mm Hg, 95% CI [-4.5 to -1.1], p = 0.002; Table 2) compared to baseline. There was no significant correlation between change in IOP and change in clinical activity score or between change in IOP and change in proptosis at 12 weeks (p = 0.546 and 0.911, respectively).

Conclusions : Among patients with TED, teprotumumab treatment was associated with a significant reduction in IOP, likely due to reduced orbital congestion.

This is a 2021 ARVO Annual Meeting abstract.

 

Table 1. Baseline patient characteristics

 

Table 2. Mean intraocular pressure readings following teprotumumab treatment (mmHg)