Few adults with thyroid eye disease receiving teprotumumab require second course
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Less than 5% of adults with thyroid eye disease who completed a full course of teprotumumab therapy required an additional course of the agent, according to a presenter at the American Thyroid Association annual meeting.
“We know from previous studies that the rate of recurrence with thyroid eye disease is anywhere between 15% and 20%,” Shoaib Ugradar, MD, oculoplastic surgeon at The Jules Stein Eye Institute at the University of California, Los Angeles, told Healio. “What this research shows us is that, of patients who receive teprotumumab therapy, only 4.9% of them went on to require further therapy over the long term. The 4.9% is much lower than the 15% to 20% of recurrence with thyroid eye disease. If you get teprotumumab, your personal risk of recurrence is much lower than if you did not receive teprotumumab.”
Researchers conducted a real-world analysis of deidentified claims data from adults who completed an uninterrupted full course of eight infusions of teprotumumab (Tepezza, Horizon Therapeutics) and were prescribed an additional course through July 2022. Researchers analyzed the number of adults prescribed an additional course as well as those who initiated retreatment, the number of infusions completed, and time between the first course and the additional course.
There were 5,845 adults who completed an initial course of teprotumumab (mean age, 57 years; 74% women). Prior to the initial course, 51% of the study cohort had a representative claim for proptosis, 31% had diplopia, 22% had lid retraction, 12% had strabismus, 10% had eye inflammation and 5% had optic neuropathy. Most adults presented with Graves’ disease before their initial course. There were 44 eye surgeries performed.
Of the study cohort, 4.9% were prescribed an additional course of teprotumumab, with 1.9% initiating the additional course by the end of July. Ugradar said the percentage of people initiating the second course will likely increase as more long-term data become available.
“One would envision that there are delays in getting reimbursements or getting access to treatment centers,” Ugradar said. “Given enough time, it will likely get much closer to 4.9%.”
Of 110 adults who initiated a second course of teprotumumab, the mean time between courses was 12 months. At the end of July, those who were taking a second course had received a mean of 5.4 infusions, and 41% had already completed the second course.
Among 76 adults who had claims data available between the first and second course of teprotumumab, 26% had proptosis, 16% had diplopia, 18% had lid retraction and 13% had strabismus.
“Proptosis and diplopia were the main reasons why patients required the first course and why they required the second course,” Ugradar said. “What we found interesting was for patients who required the second course, the magnitude of diplopia and proptosis was much reduced compared with patients requiring the first course.”
Ugradar said his institution is part of a consortium that plans to continue following adults who receive teprotumumab. Future studies plan to examine reasons some adults require additional courses of the agent and how severe their thyroid eye disease is. Researchers are also following those who have not yet needed a second course of teprotumumab to see whether they will require a second course in the future.
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Ugradar S, et al. LB 572. Presented at: American Thyroid Association Annual Meeting; Oct. 19-23, 2022; Montreal.
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