Abstract
Purpose :
Thyroid Eye Disease (TED), a vision-threatening autoimmune disease, can present with dry eyes, ocular inflammation, epiphora, diplopia, pain, vision loss, and psychosocial sequelae from proptosis and strabismus. In 2020, the FDA expedited approval of teprotumumab for use in active TED. As the IGF-1 receptor is ubiquitously expressed in the human body, its degradation by teprotumumab has extensive side effects that have had limited investigation. We present a retrospective case series on side effects and adverse events observed with teprotumumab use.
Methods :
A literature review was performed on all teprotumumab related papers from October 2014 to August 2022 to identify all reported side effects and adverse events. All patients in the university practice who underwent at least one teprotumumab infusion from February 1, 2020 to August 30, 2022 were identified. A retrospective chart review and standardized phone interview was performed to collect data demographics, medical history, side effects and adverse events. Statistical analysis was completed using Fischer’s test and contingency tables.
Results :
There were 38 patients were included in the study. Of these patients, 35 were female with an average age of 58.2 years (range of 30-85). The most reported side effects were fatigue (68.57%), brittle nails (60%), dry eyes (60%), hair loss (54.29%), muscle spasms (51.43%), and dry mouth (51.43%) [Table 1]. 10 patients (28.57%) reported new or progressive hearing loss. 3 serious adverse events were identified, including 2 blood clots and 1 pulmonary embolism. A history of diabetes was associated with increased risk of hyperglycemia(p=0.082) [Table 2]. 28 patients (73.68%) experienced symptom resolution after completing therapy, 35 (92.11%) experienced improvement of their TED with therapy, and 31 (81.58%) would recommend teprotumumab to others.
Conclusions :
Teprotumumab is the first FDA-approved monoclonal antibody that causes internalization and degradation of IGF-1 receptor. In our study, patients treated with at least one teprotumumab infusion experienced at least one side effect with most resolving after treatment completion. Most patients found the treatment efficacious (92.11%) and recommended its use (81.58%). As teprotumumab use continues to expand, it is imperative to investigate the side effects and adverse events experienced with treatment.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.