Abstract
BACKGROUND: Thyroid eye disease (TED), an autoimmune disease, causes inflammation of the periorbital fat and muscle often leading to eye-bulging (proptosis), double-vision (diplopia), pain, redness and swelling. Steroids are effective in reducing inflammation, but have limited efficacy for proptosis and diplopia, and higher doses can be associated with adverse effects. Teprotumumab, an anti-insulin like growth factor-1 receptor inhibitory antibody, demonstrates significant improvements in proptosis, diplopia and inflammatory symptoms.(1) Here we examined steroid use in the period leading up to, and the period after a full course of teprotumumab. METHODS: Deidentified claims data (IQVIA) from patients completing 8 infusions of teprotumumab (full course) before Dec 31, 2020 were examined for steroid use before and after treatment. To ensure that claims data were adequately captured, patients must have been in the database for at least 1 year before and 6 months after teprotumumab and have had a claim within 4 months of the first dose. The median cumulative dose of steroids (prednisone equivalent) was also determined. RESULTS: 565 patients met the inclusion criteria with a mean age of 59.5 (13.3) years. 407 (72%) were female and 158 (28%) were male. 460 (81%) had ≥1 steroid prescription at any time before, during, or after teprotumumab within 69 months before teprotumumab and 16 months afterward with 78% use before, 10% use during and 25% after. 314 (56%) had ≥1 steroid prescription within 1 year before or 6 months after a course of teprotumumab. Of 283 patients who received steroids within 1 year pre-teprotumumab, the median cumulative dose per patient (MCDPP) increased from 295 to 607 mg 3-0 months prior to teprotumumab initiation and 82% (233) stopped steroid use after teprotumumab initiation. The MCDPP decreased by 80% (607mg to 120mg) in the 0-3 months pre-teprotumumab to 3-6 months post-teprotumumab. Finally, the number of patients receiving steroids 3-6 months after teprotumumab decreased by 74% from 3-0 months pre-teprotumumab. CONCLUSIONS: While reasons for the escalating incidence, and magnitude, of steroid use pre-teprotumumab and reduced use post-teprotumumab could not be definitively determined, remote steroid use increased up until teprotumumab initiation with a majority of patients who had a steroid in the year preceding teprotumumab having no steroid use in the 6 months after teprotumumab. Further, the number of patients receiving steroids and the median cumulative dose of steroids post-teprotumumab was reduced by more than 70% and 80%, respectively from pre-teprotumumab doses, indicating that teprotumumab is a steroid sparing agent. Follow-up analyses will confirm the duration of this effect. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.