Biologics a game changer for management of thyroid eye disease
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CHICAGO — Biologics are a game changer for the treatment of thyroid eye disease, according to one speaker at the American Academy of Ophthalmology meeting.
“Biologics are monoclonal antibodies targeting a specific antigen and hold the promise of selective disease modification — that’s efficacy with limited side effects,” Rona Z. Silkiss, MD, said.
Rituximab was the first biologic used for thyroid eye disease (TED), described in 2009. Tocilizumab followed shortly after and was approved in 2010 by the FDA for rheumatoid arthritis.
“But the world change in terms of biologics for TED was in 2017, when the results of teprotumumab were published,” Silkiss said. “Teprotumumab is an IGF-1R receptor antagonist that blocks the TSHR/IGF-1R coactivation by [thyroid-stimulating immunoglobulin] and, consequently, the induction of proinflammatory cytokines. In 2020, teprotumumab was FDA approved for the treatment of active TED with impressive results, especially with respect to proptosis, and has also been studied for the treatment of recurrent and chronic TED.”
However, because the IGF-1R receptor is expressed in almost every cell of the body, the systemic administration of this drug has many potential side effects, including hearing loss, dysmenorrhea, muscle spasm, hair loss and ulcerative colitis. In addition, there can be a high recurrence rate. The cost of teprotumumab is also high, almost $150,000 per mm of proptosis reduction.
However, “these three drugs are just the beginning of the story, and more biologics are already in the pipeline, with different mechanisms of action,” Silkiss said. “We are looking for drugs that are modifiers of the disease but have minimum side effects and are easy to administer also early in the course of the disease to prevent chronic stigmata and make chronic disease extinct. We also want them cost-effective to limit the financial burden and increase access.”
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Silkiss RZ. Biologics for thyroid eye disease: What’s new, what’s next? Presented at: American Academy of Ophthalmology meeting; Sept. 30-Oct. 3, 2022; Chicago.
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