Teprotumumab for thyroid-associated ophthalmopathy

Terry J. Smith, George J. Kahaly, Daniel G. Ezra, James C. Fleming, Roger A. Dailey, Rosa A. Tang, Gerald J. Harris, Alessandro Antonelli, Mario Salvi, Robert A. Goldberg, James W Gigantelli, Steven M. Couch, Erin M. Shriver, Brent R. Hayek, Eric M. Hink, Richard M. Woodward, Kathleen Gabriel, Guido Magni, Raymond S. Douglas

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125 Scopus citations

Abstract

BACKGROUND Thyroid-associated ophthalmopathy, a condition commonly associated with Graves' disease, remains inadequately treated. Current medical therapies, which primarily consist of glucocorticoids, have limited efficacy and present safety concerns. Inhibition of the insulin-like growth factor I receptor (IGF-IR) is a new therapeutic strategy to attenuate the underlying autoimmune pathogenesis of ophthalmopathy. METHODS We conducted a multicenter, double-masked, randomized, placebo-controlled trial to determine the efficacy and safety of teprotumumab, a human monoclonal antibody inhibitor of IGF-IR, in patients with active, moderate-to-severe ophthalmopathy. A total of 88 patients were randomly assigned to receive placebo or active drug administered intravenously once every 3 weeks for a total of eight infusions. The primary end point was the response in the study eye. This response was defined as a reduction of 2 points or more in the Clinical Activity Score (scores range from 0 to 7, with a score of =3 indicating active thyroid-associated ophthalmopathy) and a reduction of 2 mm or more in proptosis at week 24. Secondary end points, measured as continuous variables, included proptosis, the Clinical Activity Score, and results on the Graves' ophthalmopathy-specific quality-of-life questionnaire. Adverse events were assessed. RESULTS In the intention-to-treat population, 29 of 42 patients who received teprotumumab (69%), as compared with 9 of 45 patients who received placebo (20%), had a response at week 24 (P<0.001). Therapeutic effects were rapid; at week 6, a total of 18 of 42 patients in the teprotumumab group (43%) and 2 of 45 patients in the placebo group (4%) had a response (P<0.001). Differences between the groups increased at subsequent time points. The only drug-related adverse event was hyperglycemia in patients with diabetes; this event was controlled by adjusting medication for diabetes. CONCLUSIONS In patients with active ophthalmopathy, teprotumumab was more effective than placebo in reducing proptosis and the Clinical Activity Score.

Original languageEnglish (US)
Pages (from-to)1748-1761
Number of pages14
JournalNew England Journal of Medicine
Volume376
Issue number18
DOIs
StatePublished - May 4 2017

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ASJC Scopus subject areas

  • Medicine(all)

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Smith, T. J., Kahaly, G. J., Ezra, D. G., Fleming, J. C., Dailey, R. A., Tang, R. A., Harris, G. J., Antonelli, A., Salvi, M., Goldberg, R. A., Gigantelli, J. W., Couch, S. M., Shriver, E. M., Hayek, B. R., Hink, E. M., Woodward, R. M., Gabriel, K., Magni, G., & Douglas, R. S. (2017). Teprotumumab for thyroid-associated ophthalmopathy. New England Journal of Medicine, 376(18), 1748-1761. https://doi.org/10.1056/NEJMoa1614949