Teprotumumab for Thyroid Eye Disease: Efficacy and Impact on Orbital Decompression Utilization.

OBJECTIVES

We evaluated the impact of teprotumumab therapy (TT) introduction on orbital decompression (OD) utilization for thyroid eye disease (TED) and compared rates of significant exophthalmos reduction (SER) and diplopia between TT and OD.

METHODS

Newly diagnosed TED patients treated pre (2015-2020) and post teprotumumab (2020-2025) FDA approval were identified from the EHR. Utilization trends, diplopia rates, and immediate (≤ 6 weeks post-intervention) and long-term follow-up SER (≥ 2 mm reduction) were studied.

RESULTS

Of 406 TED patients, 53 (36.8%) underwent OD in the pre-TT cohort (n = 144). Post-teprotumumab approval (n = 262), primary OD was performed in 29 (11.1%), of which 3 (10.3%) were subsequently placed on TT; primary TT was used in 68/262 (25.9%) with subsequent OD performed in 9 (13.2%). The remaining patients used other treatments (corticosteroids, orbital radiation, rituximab, tocilizumab, etc.). In the overall cohort, immediate SER was achieved in 94.4% of OD versus 83.8% of TT patients (p = 0.028), with greater median reduction in the OD group (5 vs. 4 mm; p = 0.001). At long-term follow-up (median 13 vs. 12 months), SER was sustained in 85.4% of OD and 62.9% of TT patients (p = 0.042). Pre-therapy diplopia was more prevalent in TT vs. OD patients (79.4% vs. 59.7%; p = 0.019). New-onset posttreatment diplopia was higher in the OD group (20.7% vs. 5.9%; p = 0.008).

CONCLUSIONS

Rates of OD surgery declined following FDA approval of teprotumumab. OD achieved sustained and greater exophthalmos reduction but carried a higher risk of diplopia. Contemporaneous OD indications may have evolved to use in TT-recalcitrant TED or those in need of urgent decompression.

LEVEL OF EVIDENCE: 4.