Hearing loss with teprotumumab more likely for adults with baseline hearing dysfunction
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Key takeaways:
- Half of adults receiving teprotumumab who had hearing dysfunction at baseline had a decline in hearing during therapy.
- Hearing loss was rare among adults with normal audiometry at baseline.
Hearing loss occurred more frequently among adults who received teprotumumab for the treatment of thyroid eye disease if they had impaired hearing at the start of therapy, according to a research letter published in Thyroid.
In a small prospective cohort study, one adult out of 32 (3%) with normal hearing at baseline developed hearing decline after a full, 24-week course of teprotumumab-trbw (Tepezza, Amgen). However, among 20 adults who had hearing dysfunction at baseline, 50% had a decline in hearing during teprotumumab treatment and four did not have a resolution of their hearing changes at a 6-month follow-up.
“It is important to have a baseline hearing test and then discuss the treatment plan,” Raymond S. Douglas, MD, PhD, an oculoplastic surgeon in Beverly Hills, California, told Healio. “In most cases with caution and careful attention, any long-term issues can be overcome.”
Researchers conducted a prospective observational study enrolling 52 adults with thyroid eye disease who completed a full course of eight teprotumumab infusions over 24 weeks and were assessed at a 6-month follow-up from March 2020 to August 2022 (mean age, 49 years; 82.7% women). Audiometry testing was performed at baseline, before every infusion and at 3 and 6 months after the teprotumumab course was finished.
At baseline, six participants reported otological symptoms. After the start of teprotumumab treatment, new otological symptoms were reported by 15 adults. Of that subgroup, 11 had complete resolution of their symptoms at 6 months.
“Symptom reporting is difficult to interpret as it comes from a large range of symptoms,” Douglas said of the adults reporting new symptoms during teprotumumab therapy. “Also, there is no control, so plugging of ears on one occasion could elicit symptoms. It is important to properly measure over time with audiology.”
Of the full study group, 32 adults had normal hearing at baseline. Of those with normal baseline hearing, one participant had a decline in hearing that did not resolve at 6 months follow-up. Mean hearing threshold declined from 11.7 dB hearing level (HL) at baseline to 12.5 dB HL at 6 months.
The remaining 20 adults in the study group had a baseline hearing dysfunction at one or more frequencies. Of that subgroup, 10 participants had a mild decrease in their hearing after teprotumumab treatment. Of those with a hearing decline after teprotumumab, six adults had complete resolution of their hearing at 6 months. The four adults who did not have resolution of their hearing had severe hearing loss at baseline. The mean hearing threshold for those who had hearing loss during teprotumumab therapy declined from 23 dB HL at baseline to 25 dB HL at 6 months.
Douglas said future studies should assess tests other than audiology, such as word recognition.
“Also, it is important to understand what are the minimal changes that can be reversed and if testing at 6 week increments is ideal,” Douglas said.
For more information:
Raymond S. Douglas, MD, PhD, can be reached at raymonddouglasmd@gmail.com.
Perspective
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It is estimated that up to 25% to 30% of all patients with autoimmune thyroid disease have sensorineural hearing loss. Patients can complain of symptoms such as ear fullness, tinnitus, ear pressure, and difficulty hearing others where there is background noise, such as restaurants. However, sometimes the loss is subtle. Patients receiving teprotumumab treatment should have audiology testing at baseline (prior to treatment), during treatment, after treatment and again at least 6 months after treatment, and perhaps a year after that.
Larger sample size and longer studies are warranted; however, it is important to note that in most cases the hearing loss did improve over time. The quality-of-life burden of severe thyroid eye disease may outweigh minor hearing changes, and this is a discussion that each thyroid eye disease treatment team needs to have with their patients. It is also important to note that hearing loss with treatment has rarely been observed in patients with normal audiology at baseline. Hearing loss in patients with autoimmune thyroid disease needs to be better understood as well.
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