Corticosteroids Versus Teprotumumab for the Treatment of Thyroid Eye Disease. Does Either Mitigate the Need for Additional Treatments?

Abstract

Background:

The treatment paradigm for thyroid eye disease (TED) in the United States has shifted from corticosteroids toward targeted therapies such as teprotumumab. However, it remains unknown whether teprotumumab decreases the need for subsequent treatments for TED compared with intravenous methylprednisolone (IVMP). This study compares the long-term need for additional medical or surgical interventions in TED patients treated with teprotumumab versus IVMP.

Methods:

A retrospective cohort study identified TED patients treated with IVMP or teprotumumab utilizing the TriNetX Analytics platform. Patients with comorbidities requiring high-dose steroids, prior TED therapy within 6 months, or concurrent TED treatments were excluded. Propensity score matching (PSM) adjusted for baseline demographic and TED-related risk factor differences. Patients were followed for 6, 12, and 18 months after a 6-month washout period. The primary outcome was the incidence of additional TED-related interventions. Secondary outcomes included post-treatment care trajectories, treatment burden, and complexity, assessed through longitudinal pathway analysis.

Results:

The IVMP cohort included 308 patients, and the teprotumumab cohort included 417; after PSM, each contained 263 patients. No significant differences were found in the incidence of additional TED-related interventions between cohorts. A similar percentage required additional medical therapies (41% vs. 37%, p = 0.423), while fewer in the IVMP cohort underwent additional surgical interventions (3.8% vs. 8.8%, p = 0.019, 4.8% vs. 10.0%, p = 0.040) at 12 and 18 months. Among those needing additional TED interventions, the IVMP cohort exhibited a higher treatment burden and more complex treatment trajectories, requiring a greater average number of treatments (2.34 vs. 1.34 per patient; 32.8% vs. 5.5% requiring ≥3 additional treatments).

Conclusions:

TED patients treated with IVMP or teprotumumab had similar overall rates of additional interventions. However, IVMP was associated with greater treatment complexity, requiring more varied medical therapies. Teprotumumab-treated patients typically required fewer additional medical therapies and underwent more surgical interventions as a second-line step, suggesting that teprotumumab may simplify the treatment pathway. These data have important implications for patient education and future assessment of the cost-effectiveness of TED therapies.