Teprotumumab reduces extraocular muscle and orbital fat volume in thyroid eye disease

Jain, Amy Patel; Gellada, Norman; Ugradar, Shoaib; Kumar, Ada; Kahaly, George J.; Douglas, Raymond S.

doi:10.1136/bjophthalmol-2020-317806

Cited by 36 publications

(54 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Teprotumumab has previously been shown to reduce soft-tissue expansion within the orbit. 14 The present study is the first to show a similar, significant reduction of soft tissue in the extraorbital regions of the face. Given the significant impact of disfiguring facial changes on the mental health of patients with TED, 25 the potential role of teprotumumab in this group of patients becomes more apparent.…”

Section: Discussionsupporting

confidence: 68%

See 1 more Smart Citation

Facial and Eyelid Changes in Thyroid Eye Disease Are Reversed by Teprotumumab

Ugradar

Braun

Wang

et al. 2021

Plastic and Reconstructive Surgery - Global Open

Self Cite

View full text Add to dashboard Cite

Background: Thyroid eye disease (TED) causes orbital soft-tissue expansion. Recent studies have suggested that brow and temple changes may also occur. Teprotumumab, a monoclonal antibody to the insulin-like growth factor 1 receptor reduces soft-tissue swelling in TED. In this study, we quantified the changes to pan facial soft-tissue volumes and eyelid position, following treatment with teprotumumab. Methods: In this prospective study, consecutive patients who were treated with teprotumumab were appraised for study eligibility. All patients had 3D facial imaging using the Vectra H2. Soft-tissue volume changes in the upper face, periorbita, temples, midface, and lower face were quantified before and after teprotumumab therapy. Furthermore, the marginal reflex distance (MRD)1, MRD2, and intercanthal distance were also measured pretreatment and posttreatment. Results: Twenty-three patients were included in the study. The mean duration of TED was 29 months (38). Following teprotumumab therapy, the mean (SD) decrease in volume for each region was 0.75 mL (0.84) in the upper face, 1.8 mL (1.3) in the periorbital region, 0.17 mL (0.5) in the temples, 1.62 mL (3.16) in the midface, and 2.67 mL (4.6) in the lower face. The mean (SD) decrease in the volume of the full face was 8.9 mL (8.7). There was also a significant reduction in MRD1, MRD2, and the intercanthal space following treatment. There was no relationship between previous steroid use and total body weight reduction and changes in facial volume. Conclusion: TED may cause significant tissue expansion across the entire face and this may be reduced following teprotumumab therapy.

show abstract

Section: Discussionsupporting

confidence: 68%

“…Further work has quantified a significant decrease in orbital soft-tissue volume in patients with TED. 14 …”

Section: Introductionmentioning

confidence: 99%

Facial and Eyelid Changes in Thyroid Eye Disease Are Reversed by Teprotumumab

Ugradar

Braun

Wang

et al. 2021

Plastic and Reconstructive Surgery - Global Open

Self Cite

View full text Add to dashboard Cite

show abstract

“…Jain et al describe a separate but potentially overlapping cohort of 6 patients who were imaged before and after teprotumumab treatment in the OPTIC trial. 149 In these patients, orbital fat and extraocular muscle volumes were reduced by 29% and 33%, respectively.…”

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 83%

“…The reduction of extraocular volumes and subjective diplopia after J o u r n a l P r e -p r o o f teprotumumab treatment suggests that this therapy may reduce TED-related strabismus, potentially decreasing the need for strabismus surgery in some patients and improving the chances of achieving binocularity in others. 127,134,182,183 Some patients have minimal subjective diplopia despite marked symmetric extraocular dysmotility; however, the clinical trials did not report objective measures of ocular misalignment. The trials also did not report rates of subsequent strabismus surgery following treatment vs. placebo.…”

Section: Teprotumumab and Ted-related Strabismusmentioning

confidence: 99%

Teprotumumab

Winn

Kersten

2021

Ophthalmology

View full text Add to dashboard Cite

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

show abstract

“…MRI and CT scans provide information on the amount and distribution of orbital tissue expansion (muscle thickening, fat volume increase, apical crowding). Overall, orbital MRI is indicated in patients with unilateral or strongly asymmetric exophthalmos, suspected optic neuropathy, and euthyroidism with normal thyroid serology, while orbital CT is indicated prior to decompression surgery (19)(20)(21).…”

Section: Methodsmentioning

confidence: 99%

The 2021 European Group on Graves’ orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves’ orbitopathy

Bartalena

Kahaly

Baldeschi

et al. 2021

European Journal of Endocrinology

406

340

View full text Add to dashboard Cite

Graves’ orbitopathy (GO) is the main extrathyroidal manifestation of Graves’ disease (GD). Choice of treatment should be based on assessment of clinical activity and severity of GO. Early referral to specialized centers is fundamental for most patients with GO. Risk factors include smoking, thyroid dysfunction, high serum level of thyrotropin receptor antibodies, radioactive iodine (RAI) treatment, and hypercholesterolemia. In mild and active GO, control of risk factors, local treatments and selenium (selenium-deficient areas) are usually sufficient; if RAI treatment is selected to manage GD, low-dose oral prednisone prophylaxis is needed, especially if risk factors coexist. For both active moderate-to-severe and sight threatening GO, antithyroid drugs are preferred when managing Graves’ hyperthyroidism. In moderate-to-severe and active GO, intravenous (iv) glucocorticoids are more effective and better tolerated than oral glucocorticoids. Based on current evidence and efficacy/safety profile, costs and reimbursement, drug availability, long-term effectiveness and patient choice after extensive counselling, a combination of iv methylprednisolone and mycophenolate sodium is recommended as first-line treatment. A cumulative dose of 4.5 grams (g) of iv methylprednisolone in 12 weekly infusions is the optimal regimen. Alternatively, higher cumulative doses not exceeding 8 g can be used as monotherapy in most severe cases and constant/inconstant diplopia. Second-line treatments for moderate-to-severe and active GO include: a) a second course of iv methylprednisolone (7.5 g) subsequent to careful ophthalmic and biochemical evaluation, b) oral prednisone/prednisolone combined with either cyclosporine or azathioprine; c) orbital radiotherapy combined with oral or iv glucocorticoids, d) teprotumumab; e) rituximab and f) tocilizumab. Sight threatening GO is treated with several high single doses of iv methylprednisolone per week and, if unresponsive, with urgent orbital decompression. Rehabilitative surgery (orbital decompression, squint and eyelid surgery) is indicated for inactive residual GO manifestations.

show abstract

Teprotumumab reduces extraocular muscle and orbital fat volume in thyroid eye disease

Cited by 36 publications

References 27 publications

Facial and Eyelid Changes in Thyroid Eye Disease Are Reversed by Teprotumumab

Facial and Eyelid Changes in Thyroid Eye Disease Are Reversed by Teprotumumab

Teprotumumab

The 2021 European Group on Graves’ orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves’ orbitopathy

Contact Info

Product

Resources

About