Is teprotumumab better than steroids in TED associated compressive optic neuropathy?

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Teprotumumab was found to be a rapid and effective treatment in 2 patients with thyroid eye disease associated compressive optic neuropathy (TED-CON), according to a case report, leading the authors to question whether it may be superior to intravenous (IV) corticosteroid therapy.

In the case report, 2 patients presented with active TED and mild compressive optic neuropathy with corresponding visual field (VF) defects. Visual field defects remained after IV corticosteroid therapy. Clinical improvement was made after patients began treatment with teprotumumab, eventually resulting in complete resolution of TED-CON VF defects.

“Although the role of teprotumumab in the treatment of TED-CON has yet to be evaluated in a randomized clinical trial, the rapid and complete resolution of VF defects in these 2 patients suggests that teprotumumab is effective in treating Stages 1 and 2 VF defects in TED-CON in which the duration of VF loss is up to several months,” the authors wrote.

Chiou CA, Reshef ER, Freitag SK. Teprotumumab for the treatment of mild compressive optic neuropathy in thyroid eye disease: A report of two cases. Am J Ophthalmol Case Rep. 2021;22:101075. doi: 10.1016/j.ajoc.2021.101075. PMID: 33889787; PMCID: PMC8050009.

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