Ocular Misalignment Improves With Teprotumumab Treatment

Teprotumumab can improve objective measures of ocular misalignment for patients with thyroid eye disease, according to a poster presentation offered at the North American Neuro-Ophthalmology Society conference, held in Orlando, FL, March 11-16. 

The IGF-1R antibody drug was approved in 2020 to reduce inflammation of the periocular region. That same inflammation can shift the ocular musculature out of alignment, leading to diplopia. 

To evaluate the effect of the therapy on diplopia and ocular misalignment, investigators reviewed 6 months worth of follow up from 78 participants with thyroid eye disease who experienced diplopia. Participants were divided into 2 groups, those treated with teprotumumab (n=17) and those given other treatments (n=61; 16 treated with steroids alone, 3 with orbital radiation±steroids, 42 with just observation).

Investigators monitored for changes to primary gaze ocular misalignment (measured in prism diopters at 6 months), and secondary outcomes, which induced change in ocular misalignment in secondary gazes, proptosis, eyelid position, and clinical activity score (CAS) score at 6 months, compared with the baseline. 

The researchers report that the mean (SD) change in CAS from baseline was significant for the teprotumumab group at -4.23 (1.95), but that no changes occurred in the comparison group. 

The poster shows a significant lower burden of ocular misalignment for patients treated with teprotumumab (P =.003). The multivariate model included age, duration of diplopia at baseline, change in vertical misalignment in primary gaze and up-gaze, as well as horizontal misalignment in right gaze.

“Long-term follow-up is needed to evaluate whether improvements in ocular motility are sustained and when patients with residual diplopia are suitable for surgical correction,” according to the investigators.