Does smoking decrease effectiveness of teprotumumab in thyroid eye disease?

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A small study found that several outcome measurements of teprotumumab treatment were decreased in patients who smoke. Data from the retrospective study was presented in a poster at the ASOPRS 52nd Annual Fall Scientific Symposium.

Of the 16 patients who began or completed treatment with teprotumumab during the study, 7 (43.7%) were ever-smokers. All the smokers had type 2 disease, defined in this study as diplopia within 20 degrees of fixation with restrictive myopathy.

Visual acuity outcomes were not significantly different between the groups.

Prior to treatment, 85.7% (6 out of 7) of smokers and 66.6% (6 out of 9) of non-smokers had diplopia. With treatment, 2 smokers and 4 non-smokers reported resolution or improvement in diplopia, with 1 additional smoker without diplopia prior to treatment complaining of diplopia after treatment.

There was an average reduction in clinical activity score (CAS) of 6.6 point in the 4 non-smokers who had CAS improvement. CAS improvement—from 6 to 1—was only noted in 1 smoker.

Proptosis was reduced by 1.5 mm and 2.9 mm per eye on average in smokers and non-smokers, respectively.

Miller J, et al. Effects of Smoking on Outcomes of Thyroid Eye Disease Treated with Teprotumumab. Presented at: ASOPRS 52nd Annual Fall Scientific Symposium.