Teprotumumab-trbw (Tepezza; Amgen), an FDA-approved treatment for thyroid eye disease (TED), continues to show promising real-world outcomes, according to recent studies. These findings reinforce the drug's effectiveness in reducing the need for orbital decompression surgeries and managing symptoms like diplopia and proptosis.
Retreatment Rates and Predictive Factors
A multicenter, retrospective study led by Shoaib Ugradar, MD, evaluated the retreatment rate in 119 patients who completed a full course of teprotumumab. The study revealed an overall retreatment rate of 24%, with patient age being the only significant factor correlating with the need for a second course of treatment (P < .05). Patients requiring retreatment were, on average, seven years older than those who did not (60 vs. 53 years).
The study found no significant differences between the retreated and non-retreated groups in terms of proptosis (P = .07), diplopia score (P = .4), or duration of TED (P = .4). Interestingly, 82% of re-treated patients had shown a significant proptosis response after the initial treatment. Ugradar noted, "Our study builds upon the promising findings of prior clinical trials with teprotumumab and further underscores its potential as a long-term treatment option for patients with TED."
Impact on Orbital Decompression Surgeries
Another study, led by Nicole Topilow, MD, and Don O. Kikkawa, MD, examined the impact of teprotumumab on the rate of orbital decompression surgeries. The research demonstrated a significant decrease in the number of these surgeries performed since teprotumumab became available. The study analyzed Current Procedural Terminology (CPT) codes 67445 and 67414, revealing stable usage from 2016 to 2019, followed by a marked decline from 2020 to 2023, despite an increasing number of TED patients being evaluated.
Following teprotumumab therapy, 25% of patients and 18% of orbits underwent bony decompression. Patients who underwent surgical decompression had higher pre- and post-teprotumumab exophthalmometry measurements compared to those who did not. The average time to decompression after the conclusion or cessation of teprotumumab therapy was 12.6 months.
Kikkawa stated, "The introduction of teprotumumab has had a great impact on our treatment of patients with TED, playing a key role in the reduction of orbital decompression performed at our center since its availability." He added, "Our findings suggest teprotumumab is a preferred, less invasive treatment for many patients and likely reduces the need for orbital decompression."
