Purpose

To evaluate the real-world effectiveness, treatment patterns and safety profile of mycophenolate-based immunosuppression in patients with moderate-to-severe thyroid eye disease (TED) within a UK tertiary referral ophthalmology service.

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Methods

A retrospective review was performed of consecutive patients with moderate-to-severe TED treated with mycophenolate-based immunosuppression by the oculoplastics & the immunosuppresion team of the Ophthalmology department at Leicester Royal Infirmary, seen in our clinics over the last 8 years (2018-2026). Demographic data, disease severity, concomitant steroid treatment, treatment duration, escalation to additional immunosuppression, surgical intervention and adverse events were recorded. Clinical outcomes were assessed based on TED activity status and visual function at latest follow-up.

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Results

Twenty-five patients with moderate-to-severe TED were included. Mycophenolate mofetil (MMF) was the predominant immunosuppressive agent, while 19 patients (76%) also received corticosteroids. Treatment duration ranged from 2–42 months. Disease activity improved in 15 patients (60%) and stabilised in 6 (24%), with progression despite treatment in 4 patients (16%). Visual acuity improved in most cases, worsening in only 2 patients. Six patients required escalation or conversion to azathioprine, and 6 underwent orbital decompression surgery. No patients received orbital radiotherapy. Adverse effects occurred in 7 patients (28%), most commonly malaise and mild infections. Treatment was permanently discontinued in 2 cases and temporarily interrupted in a further 2.

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Conclusion

Mycophenolate-based immunosuppression demonstrated favourable real-world disease control and acceptable tolerability in most patients with moderate-to-severe TED. Unlike controlled clinical trials, this study reflects routine NHS tertiary practice, including combined steroid therapy, escalation pathways and integration with surgical management, providing practical insight into contemporary multidisciplinary TED care.

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Additional Authors

First name	Last name	Base Hospital / Institution
Mario Frank	Farrugia	University Hospitals of Leicester
Vinaen	Charadva	University Hospitals of Leicester
Francesca	Simonini	University Hospitals of Leicester
Raghavan	Sampath	University Hospitals of Leicester
Bharat	Kapoor	University Hospitals of Leicester

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