Teprotumumab, a specific blocking antibody to the insulin like growth factor 1 receptor, significantly reduced proptosis in patients with thyroid eye disease (TED) in recent clinical trials. Given its specificity, it is expected to demonstrate greater efficacy on the worse affected orbit, in patients with asymmetric TED.
Most patients present with varying degrees of bilateral disease; however, some patients present asymmetrically. In a 2020 report on 269 TED patients, 83 (30.9%) were considered to have asymmetric disease, with a mean difference of 2.5 mm exophthalmos between the eyes. Higher disease burden among patients with asymmetric vs symmetric disease was also observed.Asymmetry has been identified as a significant contributor to psychosocial distress and impaired quality of life in patients with TED. Asymmetry also appears to be a marker for more acute, severe and possibly recalcitrant disease.
Recently,The differential impact of teprotumumab on orbits that are clinically more affected by thyroid eye disease( TED) have been noted, suggesting that teprotumumab reduces asymmetry. These research findings have recently been published in British Journal of Ophthalmology.
Researchers investigated the differential impact of teprotumumab on the orbits of such patients.Researchers conducted a pooled analysis of patients who were enrolled in the recent phase 2 (NCT01868997) and phase 3 (NCT03298867) trials, all patients with asymmetric TED (difference in exophthalmometry of ≥3 mm) were screened for eligibility. The primary outcomes of the trials, proptosis, diplopia and Clinical Activity Score (CAS) response, were evaluated in both orbits of patients who had received treatment or placebo, to examine the differential response from baseline to week 24.
Data analysis revealed the following facts.
· From a pooled group of 84 patients randomised to receive teprotumumab and 87 randomised to placebo, 10 (12%) and 12 (14%), respectively, met the inclusion criteria.
· The teprotumumab-treated patients demonstrated significant reductions in proptosis, CAS and diplopia in both orbits of each patient and this was not seen with placebo.
· The reduction in proptosis and CAS was significantly greater in the worse affected orbit, improving symmetry.
· In the placebo arm, while the mean CAS in the study eye reduced over time, proptosis and diplopia did not change in either orbit.
For the full article follow the link: http://dx.doi.org/10.1136/bjophthalmol-2020-318314
Primary source: British Journal of Ophthalmology
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