Abstract Listings 2024

Purpose

To describe the clinical outcomes of all TED patients treated with teprotumumab across various medical centers in Israel regarding proptosis reduction, diplopia, and CAS. Additionally, evaluate the response rate and side effects of the treatment in a real-world setup.

Methods

A retrospective analysis of electronic medical records for all patients treated with teprotumumab in Israel

Results

Twenty-eight TED patients (17 females, mean age of 52 years) received partial or complete Teprotumumab treatment. All patients had previously failed to respond to IV glucocorticoids with or without mycophenolate mofetil, anti-IL-6, anti-CD20, or intra-orbital triamcinolone acetonide injections. Two patients had undergone decompression surgery before treatment due to dysthyroid optic neuropathy and disfiguring proptosis, respectively. Proptosis decreased on average by 2 mm; however, this change was only marginally significant (P=0.1). The Clinical Activity Score (CAS) showed a significant improvement by an average of 2.1 points (0-4, P=0.008). Many experienced improvement after one or two infusions. One patient, with bilateral dysthyroid optic neuropathy (DON) that did not respond to simultaneous bilateral medial wall decompression, showed marked improvement in vision function after two doses of teprotumumab. Another patient experienced a flare-up after bilateral simultaneous decompression for disfiguring proptosis but improved after seven doses of teprotumumab. Two patients (7%) had mild recurrent inflammation nine months after treatment cessation and received an additional course. No serious adverse events were encountered

Conclusion

In this current retrospective cohort of Israeli TED patients, Teprotumumab, used as a second-line treatment, was found to be effective in reducing the Clinical Activity Score (CAS) and, to a lesser extent, in reducing proptosis. Additional prospective studies are required to determine its true benefits in a real-world setting

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