Abstract
PURPOSE: Prior studies have demonstrated the potential side effects of insulin-like growth factor-1 (IGF-1) inhibition for thyroid eye disease (TED) including hearing loss. In this study, we assessed changes in functional vision including visual field testing and best-corrected visual acuity (BCVA), clinical examination parameters, and spectral-domain optical coherence tomography (SD-OCT) biomarkers in patients who received insulin growth factor receptor-1 (IGF-R1) inhibition with teprotumumab for TED. DESIGN: Retrospective, noncomparative cohort. SUBJECTS: 22 eyes of 12 TED patients. METHODS AND OUTCOMES MEASURES: Retrospective chart review was conducted, with demographics, clinical examination, BCVA, Humphrey visual field (HVF), and SD-OCT data: central foveal thickness (CFT), sub-foveal choroidal thickness (SFCT), choroidal vascular index (CVI), retinal nerve fiber layer (RNFL), and ganglion cell-inner plexiform layer (mGCIPL) thickness compared between before and after an 8-infusion course of teprotumumab. Linear regression modeling with clustering was used for statistical analysis. Statistical significance was set at p < 0.05. RESULTS: Proptosis, clinical activity scores, and intraocular pressure improved. SFCT -35.7μm (p = 0.038), RNFL -5.41μm (p = 0.001), and mGCIPL -7.35μm (p = 0.010) decreased after six months. CFT and CVI did not statistically differ. BCVA and HVF mean deviation remained stable. CONCLUSIONS: There were statistically significant decreases in SFCT, RNFL, and mGCIPL in TED patients treated with teprotumumab, but no differences in CFT and CVI. Functional testing, with HVF and BCVA, was not affected, but there were significant systemic side effects including hearing loss noted in several patients. Further research is needed to understand the potential effects of IGF-1R blockade on the retina and optic nerve.