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Ophthalmology

Teprotumumab, tocilizumab effective in treating steroid-resistant thyroid eye disease

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Teprotumumab and tocilizumab have shown promise as effective alternatives for treating moderate to severe thyroid eye disease (TED) in patients who have not responded well to corticosteroid therapy, according to a study.

The study found that both medications improved inflammation and had positive outcomes in terms of reducing proptosis (bulging of the eyes) and diplopia (double vision). However, while teprotumumab demonstrated similar improvements to steroid-naïve controls, tocilizumab showed slightly lower response rates for proptosis and diplopia.

A total of 37 patients were included in the analysis, with 31 receiving teprotumumab and 6 receiving tocilizumab. The teprotumumab group was further divided into 13 cases (those who were steroid-resistant) and 18 controls (steroid-naïve patients). However, due to a lack of steroid-naïve patients treated with tocilizumab, a control subgroup for tocilizumab was not included in the analysis.

At the start of therapy, the mean age of the patients was 57 years, with a median duration of TED being 11.5 months. The median excess proptosis, which is the bulging of the eyes, was 4 mm above the upper limit of normal for sex and race.

The results at week 24 showed promising outcomes for both teprotumumab and tocilizumab. In the teprotumumab cases, there was an 81% proptosis response (a reduction of ≥2 mm), 45.5% resolution of diplopia (double vision), 85.7% disease inactivation (CAS <3, a clinical activity score), and 58.3% returned to mild disease severity as per the EUGOGO classification. Similar results were observed in the teprotumumab controls, with no significant differences between the subgroups. As for tocilizumab, it showed a 50% proptosis response, 16.7% resolution of diplopia, 100% disease inactivation, and 75% return to mild disease at week 24.

Of note, the teprotumumab cases had a slight worsening in proptosis and diplopia between weeks 24 and 52. Similarly, the tocilizumab cases showed a trend towards worsening diplopia, disease activity, and severity during the same period.

Reference
Toro-Tobon D, Rachmasari K, Bradley E, et al. Medical Therapy in Patients with Moderate to Severe, Steroid-resistant, Thyroid Eye Disease. Thyroid. 2023;doi: 10.1089/thy.2023.0167. Epub ahead of print. PMID: 37515425.

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