Diplopia was evaluated on a 4-point scale where scores ranged from 0 for no diplopia to 3 for constant diplopia. A diplopia responder was defined as a patient with baseline diplopia >0 and a score of 0 at Week 24.2,3
In the Phase 4 trial in patients with chronic TED, no differences between the teprotumumab and placebo groups were observed for diplopia endpoints. The trial was not powered to detect a treatment difference in diplopia due to the low incidence of diplopia at baseline among the study subjects.1
The Clinical Activity Score (CAS) is a composite score with equal weighting of each of these seven factors: spontaneous orbital pain, gaze-evoked orbital pain, eyelid swelling that isconsidered to be due to active TED, eyelid erythema (redness), conjunctival redness considered to be due to active TED, chemosis (swelling of the conjunctive), and inflammation of the caruncle or plica. However, the factors may not be of equal clinical weight to patients or to physicians treating these patients and as such the clinical meaningfulness is unknown.8
Phase 2 and 3: Patients with active TED were studied in 24-week, randomized, double-masked, placebo-controlled trials.2,6
In observation of 6 TEPEZZA patients who had an orbital MRI (12 eyes total), a decrease in orbital fat and muscle volume was shown. Analysis is exploratory and has not been adjusted for multiple comparisons. No conclusions of statistical or clinical significance can be drawn.
Phase 4: Patients with chronic TED studied in a 24-week, randomized, double-masked, placebo-controlled trial.1
GO-QOL (Graves’ ophthalmopathy quality of life patient-reported questionnaire) is a 16-item self-administered questionnaire divided into 2 subscales that is used to measure changes over time in visual functioning and appearance. Equal weight is assigned to 8 measures of visual functioning and appearance, respectively, however their relative importance is unknown. The GO-QOL is not validated in patients with TED. As such, results should be interpreted with caution.2
“Without TEPEZZA, I don’t think that I would have been able to go back to work. When working on a computer all day, the double vision would have made it impossible.”
—Bonnie S., real TEPEZZA patient
Follow-up analyses of outcomes in Phase 2, Phase 3 (OPTIC study), and OPTIC Extension (OPTIC-X) (N=112)11
of TEPEZZA patients did not
report
additional treatment for
TED,
including surgery11
Proptosis responders who flared and
received an additional course were
excluded from the additional treatment
count if they were still ≥2 mm proptosis
improvement from baseline (n=6).11
“My symptoms haven’t returned since I finished treatment. I feel in control again.”
—Paris M., real TEPEZZA patient
My name is Amina Malik and I'm an oculoplastic surgeon at Houston Methodist Hospital in Houston, Texas. I have a busy oculoplastics practice there with a big proportion of patients with thyroid eye disease.
Thyroid eye disease is a very heterogeneous disease. I think it's important for general practitioners, general ophthalmologists, endocrinologists, just to be aware that it can present in a variety of ways. We all think of [00:10:30] proptosis or lid retraction as the classic signs of thyroid eye disease, but symptoms such as dry eye or burning or redness, eyelids, swelling, pain or pressure, or a discomfort around their eyes, those can also be clues of an underlying thyroid eye disease. I think it's important when general practitioners hear those symptoms that they consider referring to a TED specialist so that they can catch the disease early in the process and hopefully optimally treat them
[00:03:00] Thyroid eye disease can be a very debilitating process. It can affect patients not just in terms of their eyes, their vision but it can really affect them from a psychosocial aspect where they have a marked change in their appearance and it can affect their daily functioning. Patients may not want to go out in public, they don't want to take pictures, they can be ashamed of the way their eyes look. I've had more than one patient in my office in tears because of how this disease has affected them.
I've been treating [00:14:00] patients with TEPEZZA from the onset since 2020 and I have had excellent experience in seeing market transformations in my patients. It can have huge impacts on my patients' quality of life with a decrease in their proptosis, their physical changes that can have, again, huge psychosocial burdens on their daily functioning of life, double vision. I've seen huge improvements in that.
I've also treated it in patients who have optic [00:14:30] neuropathy where we've restored their vision. Whereas in other patients, they might have milder disease and yet I've still treated them and have seen really significant improvements there as well.
There definitely is a subset of patients, who are still very bothered by pain or pressure behind their eyes and other symptoms that would prompt them to want to pursue treatment with TEPEZZA.
The spectrum for which I have had experience is quite broad and the results have been really dramatic.
When I speak to my [00:21:30] patients who have thyroid eye disease who are symptomatic enough to want to consider therapy, I go over the options of TEPEZZA as the first FDA-approved treatment and only FDA-approved treatment for thyroid eye disease and I'll go over the side effects and potential risks involved.
Prior to the development of TEPEZZA, the treatment options for thyroid eye disease were really limited and surgery was really the mainstay. It's been really remarkable to now have something to offer my patients that is a medical option and yet really effective. It's just really exciting to see the gratitude that patients have for the transformations that they've seen [00:27:30] after treatment with this drug.
It's really changed the entire treatment of thyroid eye disease for me.
*Euthyroid or with mild hypo- or hyperthyroidism defined as free thyroxine (FT4) and free triiodothyronine (FT3) levels <50% above or below the normal limits (every effort should be made to correct the mild hypo- or hyperthyroidism promptly).4
*Euthyroid or with mild hypo- or hyperthyroidism defined as free thyroxine (FT4) and free triiodothyronine (FT3) levels <50% above or below the normal limits (every effort should be made to correct the mild hypo- or hyperthyroidism promptly).4
Infusion Reactions: TEPEZZA may cause infusion reactions. Infusion reactions have been reported in approximately 4% of patients treated with TEPEZZA. Reported infusion reactions have usually been mild or moderate in severity. Signs and symptoms may include transient increases in blood pressure, feeling hot, tachycardia, dyspnea, headache, and muscular pain. Infusion reactions may occur during an infusion or within 1.5 hours after an infusion. In patients who experience an infusion reaction, consideration should be given to premedicating with an antihistamine, antipyretic, or corticosteroid and/or administering all subsequent infusions at a slower infusion rate.
Preexisting Inflammatory Bowel Disease: TEPEZZA may cause an exacerbation of preexisting inflammatory bowel disease (IBD). Monitor patients with IBD for flare of disease. If IBD exacerbation is suspected, consider discontinuation of TEPEZZA.
Hyperglycemia: Increased blood glucose or hyperglycemia may occur in patients treated with TEPEZZA. In clinical trials, 10% of patients (two-thirds of whom had preexisting diabetes or impaired glucose tolerance) experienced hyperglycemia. Hyperglycemic events should be controlled with medications for glycemic control, if necessary. Assess patients for elevated blood glucose and symptoms of hyperglycemia prior to infusion and continue to monitor while on treatment with TEPEZZA. Ensure patients with hyperglycemia or preexisting diabetes are under appropriate glycemic control before and while receiving TEPEZZA.
Hearing Impairment Including Hearing Loss: TEPEZZA may cause severe hearing impairment including hearing loss, which in some cases may be permanent. Assess patients’ hearing before, during, and after treatment with TEPEZZA and consider the benefit-risk of treatment with patients.
The most common adverse reactions (incidence ≥5% and greater than placebo) are muscle spasm, nausea, alopecia, diarrhea, fatigue, hyperglycemia, hearing impairment, dysgeusia, headache, dry skin, weight decreased, nail disorders, and menstrual disorders.
TEPEZZA is indicated for the treatment of Thyroid Eye Disease regardless of Thyroid Eye Disease activity or duration.
Please see Full Prescribing Information for more information.
WARNINGS AND PRECAUTIONS Infusion Reactions: TEPEZZA may cause infusion reactions. Infusion reactions have been reported in approximately 4% of patients treated with TEPEZZA. Reported infusion reactions have usually been mild or moderate in severity. Signs and symptoms may include transient increases in blood pressure, feeling hot, tachycardia, dyspnea, headache, and muscular pain. Infusion reactions