Tepezza brought ‘notable change in practice pattern’ for thyroid eye disease
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CHICAGO — Since its approval in 2020, Tepezza has become a go-to treatment for moderate to severe thyroid eye disease, unseating orbital decompression as the most used treatment, according to a presenter here.
“Our study demonstrates a notable change in practice pattern for the treatment of moderate to severe thyroid eye disease at one academic institution since teprotumumab became widely available,” Nicole J. Topilow, MD, of the University of California San Diego, said at the ASOPRS Fall Scientific Symposium.
Topilow presented a retrospective chart review that included 41 patients with moderate to severe thyroid eye disease who received Tepezza (teprotumumab, Horizon Therapeutics) injections as well as a control group of 27 patients with moderate to severe thyroid eye disease treated between September 2018 and June 2019. In the teprotumumab group, 32 patients completed all eight infusions.
Topilow showed that eight patients (20%) in the teprotumumab group underwent a bony orbital decompression while 23 patients (85%) in the control group underwent the same procedure (P < .0001).
“Rates of orbital decompression significantly decreased for patients treated with teprotumumab compared to the control population of patients treated before FDA approval,” she said.
Next, Topilow showed the 5-year trends for the institutional use of CPT code 67445, which is used for lateral orbitotomy with bone removal for decompression. In 2016 through 2019, the code was used at least 35 times each year, with it used 39 times in 2016 and 2019. In 2020, the code was used 18 times and, in 2021, just 13 times.
“Institutional use of CPT code 67445 ... declined with the FDA approval of teprotumumab in January of 2020,” she said.
Topilow acknowledged that the small sample size and the COVID pause to elective procedures may have affected the use of the CPT code. Yet, the decline persisted beyond the resumption of elective procedures, she said.
“While it appears that despite teprotumumab being highly efficacious at proptosis reduction, orbital decompression is still needed in a moderate percentage of treated patients,” Topilow said.
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Topilow N, et al. Clinical practice patterns for thyroid eye disease in the biologic era. Presented at: ASOPRS Fall Scientific Symposium; Sept. 29-30, 2022; Chicago.
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