Dr Robert Fante Outlines the Importance of Teprotumumab, the First Approved Therapy for TED

Unlike other options in the past, teprotumumab actually addresses bulging eye and double vision associated with thyroid eye disease (TED), which patients primarily care about, explained Robert G. Fante, MD, FACS, president of the American Society of Ophthalmic Plastic & Reconstructive Surgery and facial plastic surgeon and cosmetic surgeon, Fante Eye & Face Centre in Denver, Colorado.

Transcript

Teprotumumab is the first therapy approved for thyroid eye disease: what are the other options for patients to manage thyroid eye disease?

We haven't had a lot of great options in the past. We've used steroids and radiation in the past. There's been some targeted therapies that have not really been very helpful. They've all helped with the inflammatory phase but haven't really affected the actual things that patients care about, which are the proptosis and diplopia, which are their primary concerns, as well as the risk of losing vision. Surgery has been one of our options, as well. But nothing has been particularly targeted toward the actual cause of the disease.

What is the importance for patients of having an approved therapy?

It's exciting for us because as teprotumumab attacks the actual, or at least one of the, major causes for the disease, and in so doing, not only reduces, for most patients anyway, the inflammatory process but also reduces the disability and the problems that are associated with it, particularly exophthalmos and diplopia, which are the 2 things that are mostly disabling for patients, both in terms of their social lives and their functional work lives, and as a consequence, it has a lot of substantial benefit for people.

Are all adults with thyroid eye disease eligible for teprotumumab?

The FDA approval is not specific. And so, anybody with thyroid eye disease is potentially treatable. The scientific community wants to be responsible about making sure that this treatment is used for the people who can benefit the most. And so, there still are ongoing trials looking at who can most benefit. The original trials that provided FDA approval looked at patients who had disease severity that was moderate to severe and that had had duration of 9 months or less.

That certainly is an important subset of people, but there's lots of other patients who have much more chronic disease, or who have different kinds of symptoms. And among the questions is whether or not teprotumumab is useful for those patients.

Recent studies that have been published within the last year are helpful to that. Dr [Shoaib] Ugradar and colleagues last summer looked at a group of chronic patients, for example, that was published in Nature, for whom, again, teprotumumab appears to be very helpful.

So, I think the jury's a little bit out on exactly who is most benefited by this and who are the appropriate candidates from a scientific point of view. From the FDA’s point of view, everyone is eligible.