The Efficacy and Safety of Teprotumumab in Geriatrics Patients: A Multicenter Study.

PURPOSE: To evaluate the efficacy and safety of teprotumumab for the treatment of thyroid eye disease in geriatric patients.

METHODS

This was a multicenter cohort study of patients aged 75 and older, treated between February 2020 and September 2023 across 10 tertiary institutions. Patients were included if they had moderate-to-severe thyroid eye disease and at least 1 infusion of teprotumumab. Efficacy outcome measures included improvement in clinical activity score, proptosis, and Gorman diplopia score. Safety outcome measures included teprotumumab-related adverse event (TAE) incidence, onset, and severity.

RESULTS

Fifty patients (40 females, 10 males), average age of 79.2 years, were evaluated. Patients received an average of 6.9 infusions, with 34.0% (17/50) discontinuing treatment due to TAEs. Mean baseline clinical activity score was 4.0 ± 1.6, with a mean reduction of 4.0 ± 1.1. Proptosis improved by ≥2 mm in 86.0% (43/50) of patients, with a mean reduction of 4.24 mm. Of patients with baseline diplopia, 42.9% (18/42) experienced an improvement in Gorman diplopia score. Proptosis regression occurred in 62.5% (15/24) of patients at 2.5 years, and 27.9% (12/43) experienced thyroid eye disease reactivation on average 49.8 weeks posttreatment completion. TAEs were reported by 78.0% (39/50) of patients, with 30% (15/46) experiencing moderate TAEs and 14% (7/50) severe TAEs. The most common TAEs were muscle cramps (42.0%, 21/50), hearing impairment (38.0%, 19/46), and hyperglycemia (36.0%, 18/46).

CONCLUSIONS

Teprotumumab is effective in reducing clinical activity score and proptosis in geriatric thyroid eye disease patients with short-term follow-up; however, high rates of adverse events, reactivation, and proptosis regression over time warrant extreme caution and selective use in this population.