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Analysis compares teprotumumab vs intravenous methylprednisolone vs placebo in TED

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Results from a meta-analysis suggest that the use of intravenous methylprednisolone (IVMP) in patients with thyroid eye disease (TED) may result in modest or not clinically relevant changes from baseline in proptosis and diplopia compared with placebo, while teprotumumab, compared with IVMP, was associated with greater improvements.

In this matched-adjusted indirect comparison of teprotumumab versus IVMP versus placebo, 1 reviewer and 1 verifier reviewed applicable randomized/observational studies for study characteristics, eligibility criteria, baseline characteristics, and outcomes.

The main outcomes were changes in proptosis and diplopia response (percentage with ≥1 grade reduction) from baseline to week 12 in patients receiving IVMP and placebo, and to week 24 in patients receiving teprotumumab.

A total of 1019 records and 6 through manual searches, alerts, and secondary references were identified. In the matching-adjusted indirect comparison, 12 IVMP studies were included. Comparator studies included:

-11 for proptosis change (n  =  419)
-4 for diplopia response (n  =  125)
-2 teprotumumab (n  =  79) and placebo (n  =  83)

From baseline to week 12, treatment with IVMP resulted in a proptosis difference of −0.16 mm (95% CI, −1.55 to 1.22 mm) versus placebo. There was a −2.31 mm difference in proptosis treatment between IVMP and teprotumumab, favoring teprotumumab.

Diplopia response with IVMP treatment (odds ratio, 2.69; 95% CI, 0.94-7.70) was not favored over placebo. Teprotumumab was favored over IVMP (odds ratio, 2.32; 95% CI, 1.07-5.03) in odds of diplopia response.

Douglas RS, Dailey R, Subramanian PS, et al. Proptosis and Diplopia Response With Teprotumumab and Placebo vs the Recommended Treatment Regimen With Intravenous Methylprednisolone in Moderate to Severe Thyroid Eye Disease: A Meta-analysis and Matching-Adjusted Indirect Comparison. JAMA Ophthalmol. Published online February 17, 2022. doi:10.1001/jamaophthalmol.2021.6284