Dr Rona Silkiss Details the Use of Biologics to Treat Thyroid Eye Disease

Transcript

How has the use of biologics for thyroid eye disease grown over time and how is research in this space expected to develop?

Silkiss: It is a very exciting time to be treating thyroid eye disease. The notion of using a biologic began in 2009 with Laszlo Hegedus, who suggested that we try utilizing rituximab for thyroid eye disease. Since that time, rituximab, tocilizumab, and teprotumumab [teprotumumab-trbw] have been used in the United States for thyroid eye disease. Teprotumumab, of course, is the only drug that's currently FDA-approved for this indication. Rituximab and tocilizumab have been studied in clinical trials extensively and have been utilized as well.

But the space is just beginning to open up with great interest from the pharmaceutical industry and there are a dozen or more similar type of drugs in the pipeline. They could be various forms of IGF-1R [insulin-like growth factor type 1 receptor] inhibitors, an FcRn [neonatal Fc receptor ] inhibitor, TSHR [thyrotropin receptor] inhibitor, and IL-17 [interleukin 17] and IL-11 inhibitors, etc. I think the future is going to be filled with a lot of exciting developments in this field.

What can health care professionals in ophthalmology do to ease new patients and their caregivers into using biologic therapies, especially as “biologic” is not a household term?

Silkiss: Well, the first thing is that as a health care provider, we want to provide the absolute best health care to our patients. And by that I mean that we want to diagnose our patients correctly, and give them the full array of therapeutic modalities that they can choose from. And specifically, not only provide informed consent, but incorporate their comorbidities into the decision making.

So, for a young woman that might wish to become pregnant, she would not want to use certain biologics if she developed thyroid eye disease because of the risk to a pregnancy. If someone were a diabetic, they may choose not used a biologic, etc. So, this is a complex space. And though each of these biologics has great promise and therapeutic advantage, in some respects, they also come with adverse events, and we need to carefully weigh what the word "efficacy" means for the individual patient.

What more needs to be done to ensure that patients with thyroid eye disease and other ophthalmic conditions have adequate access to biologic therapies?

Silkiss: Well, we're hoping that the biologic space becomes very crowded, so that the cost of treatment decreases significantly so that we can provide access and equity to our patient population, not only in the United States, but around the world. Currently, the FDA-approved biologic is quite expensive, and that poses a challenge for providing this for patient care.

My hope is that as the space becomes more competitive, that the price will adhere to market forces and will decrease accordingly and that there will be a wider range of biologics to treat patients that have various stages of the disease and also, we can be selective in terms of providing exactly the right biologic for the patient depending on their state of disease and comorbidities.