Abstract
Purpose :
Thyroid Eye Disease (TED) is an autoimmune disease that can impair vision and appearance. Corticosteroids were the mainstay of treatment for TED until teprotumumab, an antibody to the Insulin-like growth factor 1 receptor, was approved in January 2020. This study compares corticosteroids and teprotumumab by assessing the necessity for subsequent therapeutic interventions.
Methods :
A retrospective cohort study was performed using TriNetX Analytics electronic health record (EHR) database. Patients were divided into intravenous methylprednisolone (IVMP) or teprotumumab cohorts. IVMP group was defined as patients with disorders of the thyroid gland (ICD-10 code E00-E07), expressing TED symptoms identified via ICD-10 codes, and required a minimum of 6 IVMP infusion. Teprotumumab group included those who received at least one teprotumumab infusion. Patients were followed for 1-year post-treatment. Propensity score matching (PSM) matched for demographics. Outcomes included TED-related surgical interventions such as orbital decompression, strabismus, and eyelid surgery and need for additional medical therapy including other types of corticosteroids or immunomodulatory drugs post-treatment. Data collection occurred on December 4, 2023, with t-tests analysis applied to categorical data.
Results :
There were 424 patients in each group after PSM. The teprotumumab cohort (mean age 56.5, 77.4% female) required less additional medical (OR, 3.8; 95% CI, 2.5-5.9) and steroid therapies (OR, 5.8; 95% CI, 4.0-8.5) but higher TED surgery rate (OR, 0.3; 95% CI, 0.1-0.6) within 1-year post-treatment compared to the IVMP group. Moreover, the IVMP group had a more complex therapeutic journey involving multiple sequential and combined treatment steps.
Conclusions :
Our findings suggest that active TED patients treated with teprotumumab required less additional steroid and medical interventions in a 1-year follow-up period compared to patients treated with IVMP. Interestingly, the teprotumumab treated group underwent more TED surgery within the same follow-up period. Additional studies are needed to understand if teprotumumab increases the need for additional surgery or effectively stabilizes inflammation allowing patients to successfully undergo earlier rehabilitative surgery.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.