Teprotumumab may provide better outcomes than IV methylprednisolone in thyroid eye disease
IV methylprednisolone was linked to a small change in proptosis from baseline compared with placebo in patients with thyroid eye disease, while teprotumumab may improve proptosis and diplopia vs. IV methylprednisolone.
Treatment options to improve proptosis and diplopia in thyroid eye disease are limited. Recent guidelines recommend IV methylprednisolone for most patients with moderate to severe active thyroid eye disease, but the dose, timing and duration of therapy vary in the literature. Tepezza (teprotumumab, Horizon Therapeutics) is FDA approved for thyroid eye disease but has not been compared with IV methylprednisolone.
In a meta-analysis and matching-adjusted indirect comparison, researchers identified 12 studies on IV methylprednisolone, teprotumumab and placebo. They evaluated changes in proptosis by millimeter and diplopia response from baseline to week 12 in those who received IV methylprednisolone and to week 24 in those who received teprotumumab.
IV methylprednisolone improved proptosis by –0.16 mm. The difference in proptosis between IV methylprednisolone and teprotumumab was –2.31 mm, favoring teprotumumab. IV methylprednisolone did not improve diplopia response vs. placebo, while teprotumumab was favored over IV methylprednisolone.
“While this nonrandomized comparison suggests that teprotumumab, as compared with [IV methylprednisolone], is associated with greater improvements in proptosis and may be twice as likely as to have a one grade or higher reduction in diplopia, [randomized controlled trials] comparing these two treatments would be warranted to determine if one treatment is superior to the other to a clinically relevant degree,” Raymond S. Douglas, MD, PhD, and colleagues wrote.
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