From supportive therapy to disease-modifying: How the management of TED has changed

With the 2020 approval of teprotumumab (Tepezza; Horizon Therapeutics), the treatment and management of thyroid eye disease (TED) has been able to transition from supportive therapy to disease-modifying treatment, according to a presentation by Roger Dailey, MD, FACS at Hawaiian Eye and Retina 2021.

Prior to 2020, the management of TED was centered mainly around supportive therapy, including smoking cessation, changing sleeping positions, using sunglasses, and offering support. Traditional treatment options, Dr Dailey said, included the use of steroid, radiation, orbital decompression, or upper lid retraction repair in patients with active TED and rehabilitative surgery, orbital decompression, strabismus surgery, and eyelid surgery in patients with inactive TED. However, these treatments did not ultimately reverse proptosis or strabismus or “reverse the underlying alterations of orbital tissue,” he said.

In 2020, teprotumumab became the first treatment for TED approved by the U.S. Food and Drug Administration. It has demonstrated a significant reduction in proptosis, and according to Dr Daily, supports “a positive benefit/risk profile in the treatment of TED, with apparent disease-modifying activity.”

Dr Daily concluded his presentation by highlighting the impact the teprotumumab has had on not just patients’ symptoms but also their overall treatment experience. In one case, his patient went from 30 office visits and spending nearly $630 on gas prior to 2020 to 1 office visit and 2 infusion center visits and $45 on gas post-2020. Similarly, the patient missed more than 9 weeks of work, costing nearly $25,000, pre-2020 and only missed 1 day of work, costing $275, post-2020.

Reference
Daily R. Thyroid Eye Disease Management: Where are we in 2021. Presented at: Hawaiian Eye and Retina 2021.