Reduction of Teprotumumab-Induced Hearing Loss With Comparable Efficacy Using Half-Dose Therapy

Area of Science:

• Ophthalmology
• Endocrinology

Background:

• Thyroid eye disease (TED) is a serious condition affecting the eyes.
• Teprotumumab is an effective treatment for TED but can cause adverse events, including sensorineural hearing loss.

Observation:

• A patient with moderate-severe TED developed significant sensorineural hearing loss after four teprotumumab infusions.
• Standard treatments failed to resolve her worsening TED symptoms.
• Restarting teprotumumab at half the dose (10 mg/kg) for eight infusions led to symptom resolution and improved tolerability.

Findings:

• Reduced-dose teprotumumab achieved significant improvement in proptosis, double vision, and orbital inflammation.
• The patient tolerated the lower dose with fewer adverse events, notably without a return of severe hearing loss.
• This case demonstrates the efficacy and improved safety profile of a modified dosing regimen.

Implications:

• Lower-dose teprotumumab may be a viable option for active moderate-severe TED patients who experience intolerable adverse events.
• This strategy could expand treatment accessibility for patients sensitive to standard dosing.
• Further research into dose optimization for teprotumumab in TED is warranted.