Teprotumumab more Beneficial Than IV Methylprednisolone in Patients with Proptosis & Diplopia

In this study, the researchers included de-identified patient-level data from teprotumumab trials and aggregate-level. They included 12 IVMP studies in the matching-adjusted indirect comparison (11 for proptosis change [n = 419], 4 for diplopia response [n = 125], and 2 teprotumumab [n = 79] and placebo [n = 83] comparator studies). The major outcome assessed was the changes in proptosis by millimetre and diplopia response (percentage with ≥ 1-grade reduction) from baseline to week 12 in patients receiving IVMP and placebo and to week 24 in patients receiving teprotumumab.

Key findings of the study:

• Upon analysis, the researchers found that treatment with IVMP resulted in a proptosis difference of −0.16 mm from baseline to week 12 vs placebo.
• They noted that the proptosis treatment difference between IVMP and teprotumumab of −2.31 mm favored teprotumumab.
• They observed that treatment with IVMP (odds ratio, 2.69) was not favored over placebo in odds of diplopia response; however, teprotumumab was favored over IVMP (odds ratio, 2.32).

The authors concluded, "This meta-analysis suggests that use of IVMP is associated with a small, typically not clinically relevant, change from baseline in proptosis vs placebo, with modest changes in diplopia"

They further added, "While this nonrandomized comparison suggests that use of teprotumumab, compared with IVMP, is associated with greater improvements in proptosis and maybe twice as likely to have a 1 grade or higher reduction in diplopia, randomized trials comparing these 2 treatments would be warranted to determine if 1 treatment is superior to the other to a clinically relevant degree."

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DOI: 10.1001/jamaophthalmol.2021.6284