From the Guidelines
Teprotumumab is effective in reducing proptosis and clinical activity score of disease in patients with active thyroid eye disease (TED), but its use in iodine and smoke induced orbitopathy is not well established and should be considered with caution. According to the study published in Ophthalmology in 2024 1, teprotumumab, a human monoclonal antibody inhibitor of IGF-IR, has been shown to improve subjective diplopia scores in both active and chronic TED and reduce the need for strabismus surgery. However, the study also notes that teprotumumab is not universally available, is associated with a number of adverse reactions, and is not suitable for everyone.
Some key points to consider when evaluating the use of teprotumumab in iodine and smoke induced orbitopathy include:
- The patient's overall health status and presence of any contraindications, such as inflammatory bowel disease or pregnancy 1
- The severity of the orbitopathy and the presence of any compressive optic neuropathy or significant strabismus 1
- The potential benefits and risks of teprotumumab treatment, including the possibility of adverse reactions such as hyperglycemia, muscle spasms, and hearing impairment 1
- The availability of other treatment options, such as corticosteroids, orbital radiation, or surgical decompression, and the potential for these treatments to be more effective in certain cases 1
In terms of treatment approach, the study suggests that patients with iodine-induced or smoking-related orbital inflammation might benefit from more established treatments first, including corticosteroids, orbital radiation, or surgical decompression depending on severity 1. Smoking cessation is essential for any patient with orbitopathy, as smoking worsens orbital inflammation and reduces the effectiveness of treatments. For iodine-induced cases, avoiding excess iodine exposure would be important. Before considering teprotumumab for these specific causes, consultation with an oculoplastic specialist or orbital disease expert is recommended to evaluate appropriateness, as this would represent off-label use with significant cost implications.
From the FDA Drug Label
Reduction in proptosis was similar between smokers and non-smokers in both studies. The effectiveness of teprotumumab in iodine and smoke induced orbitopathy is not directly addressed in the provided text, as it specifically discusses Thyroid Eye Disease. However, it does mention that 27% of patients were smokers at baseline and that reduction in proptosis was similar between smokers and non-smokers in both studies 2.
- The studies do not provide information on iodine-induced orbitopathy.
- The information on smoke-induced orbitopathy is indirect and limited to the fact that smokers and non-smokers had similar reductions in proptosis.
From the Research
Teprotumumab Effectiveness in Iodine and Smoke Induced Orbithopathy
- Teprotumumab has been shown to be effective in treating thyroid eye disease (TED), including proptosis, diplopia, and quality of life 3, 4, 5, 6, 7.
- The drug has been approved by the FDA for the treatment of TED and has demonstrated substantial and rapid improvement in clinical activity score and proptosis reduction compared to placebo 3, 5.
- Teprotumumab has also been shown to be effective in patients with chronic TED, with significant reductions in proptosis, inflammation, diplopia, strabismus, and orbital soft tissue volume 7.
- The treatment has been recommended as first-line therapy for patients with clinically significant ophthalmopathy, including those with disease duration exceeding 9 months 6.
- However, there is limited information on the effectiveness of teprotumumab in iodine and smoke induced orbithopathy specifically, as the studies primarily focused on TED in general 3, 4, 5, 6, 7.
Patient Subgroups and Response to Teprotumumab
- Teprotumumab has been shown to be effective in various patient subgroups, including those with tobacco use, older age, and higher clinical activity scores 3, 4.
- However, the response to teprotumumab may vary depending on the subgroup, with some patients experiencing a greater reduction in proptosis and improvement in diplopia than others 3, 4.
- Further studies are needed to fully understand the effectiveness of teprotumumab in different patient subgroups and to identify potential predictors of response to treatment.