Surgical decompression best for proptosis reduction in high fat-to-muscle ratio TED
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CHICAGO — Pretreatment evaluation of fat-to-muscle ratio in thyroid eye disease will allow for the best treatment choice, a presenter here said.
“We found that those with a low fat-to-muscle ratio had similar levels of proptosis reduction with teprotumumab as compared to surgical decompression,” Michelle Ting, MA (Cantab), FRCOphth, of the Shiley Eye Institute at UC San Diego, said at the ASOPRS Fall Scientific Symposium. “By contrast, in patients with a high fat-to-muscle ratio, it appears that orbital decompression is associated with a greater level of reduction in proptosis than teprotumumab.”
The single-center retrospective cohort study included 160 adults with thyroid eye disease (TED)-related proptosis who underwent bony surgical decompression and 38 patients who underwent the eight-dose course of Tepezza (teprotumumab, Horizon Therapeutics). Patients younger than age 18 years, those who received both treatments or those who had no orbital imaging were excluded.
Ting and colleagues used Epic to gather information on age, sex, type of treatment and imaging and then stratified patients with TED into type 1 — fat predominant with high fat-to-muscle ratio (FMR) — and type 2 — muscle predominant with low FMR — to determine if either group had better outcomes with surgical vs. medical treatment.
“In subjects with low fat-to-muscle ratio, ... there was no difference in proptosis reduction between teprotumumab and surgical decompression,” Ting said. “In contrast, in patients with a high fat-to-muscle ratio, surgical decompression led to significantly more proptosis reduction than teprotumumab by an average of 3 mm.”
In the low FMR group, the difference between proptosis reduction in the two groups was –0.33 mm. In the high FMR group, the difference was –3 mm with a greater reduction seen with surgical decompression (P < .001).
“Pretreatment fat-to-muscle ratio is a useful tool in predicting whether a patient will respond better to teprotumumab or surgery, and therefore, we would still consider surgical decompression as first-line treatment for patients with a high fat-to-muscle ratio,” Ting said.
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Ting M, et al. A comparison of proptosis reduction with teprotumumab vs surgical decompression based on fat-to-muscle ratio in thyroid eye disease. Presented at: ASOPRS Fall Scientific Symposium; Sept. 29-30, 2022; Chicago.
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