The Efficacy of Teprotumumab for Chronic, Progressive Thyroid Eye Disease Greater Than 9 Months

Abstract Purpose: To evaluate the efficacy of teprotumumab for treatment patients with chronic, progressive Thyroid Eye Disease (TED) who do not meet inclusion and exclusion criteria used in prior clinical trials. Methods: This is a prospective case series TED, defined as ocular symptoms more than 9 months to initiation teprotumumab, an insulin-like growth factor I receptor inhibitor (10 mg/kg first infusion then 20 subsequent infusions, every three weeks total 8 infusions). study included Clinical Activity Score (CAS) greater or equal 4. Data collected patients’ age, sex, race, baseline thyroid status, stimulating immunoglobulin, CAS, smoking best corrected visual acuity, intraocular pressure, Schirmer’s, pupil exam, extraocular motility, Gorman diplopia score, exophthalmometer measurements. Pre-infusion post-infusion external photos all gazes, orbital imaging (CT MRI), Humphrey fields optical coherence tomography were obtained when possible. Results: Ten chronic TED treated either primary following other interventions including oral prednisone, intravenous methylprednisolone, radiation, decompression and/or eyelid surgery. The age range was 55 79, 5 female male patients. Four African American 6 White/Non-Hispanic. number years had been diagnosed Graves’ disease ranged from 4 33 years, involvement spanning 15 years. Patients CT scans orbits document muscle size initiation, taken at each visit. All improved subjectively after objectively by fourth infusion. We will report long-term follow-up infusions ENDO2021. Discussion: Teprotumumab fully human monoclonal IgG1 antibody that blocks IGF-1 receptor, disrupting cell-to-cell signaling immunologic cascade independent duration severity TED. At this time, FDA approval without any specific restrictions. However, our teprotumumab-treated those would have excluded phase 2 3 trials due to: (1) poor control, (2) previous surgery, (3) therapeutic steroids (4) loss compressive optic neuropathy exposure keratopathy (5) months. In series, we found effective wider population