Surgical Timing for Patients With Thyroid Eye Disease Treated With Teprotumumab: A Collaborative Multicenter Study

Area of Science:

• Ophthalmology
• Endocrinology

Background:

• Thyroid eye disease (TED) is an autoimmune condition affecting the orbits.
• Teprotumumab is a novel biologic treatment for moderate-to-severe TED.
• Surgical interventions are common in managing TED sequelae.

Purpose of the Study:

• To compare regression rates, characteristics, and surgical outcomes in TED patients undergoing orbital, strabismus, or eyelid surgery at different times relative to teprotumumab treatment.
• To evaluate the impact of surgery timing on the need for further interventions.

Main Methods:

• A multicenter, retrospective, observational cohort study was conducted.
• Adult patients with TED receiving at least 4 teprotumumab infusions and undergoing eye surgery during or after treatment were included.
• Patients were divided into two groups: surgery within 180 days (G1) or 180 days or more (G2) after the last teprotumumab infusion.

Main Results:

• Fifty-three patients (78 surgeries) were analyzed; 34 surgeries in G1 and 44 in G2.
• Postoperative regression rates were similar between G1 (20.8%) and G2 (14.7%) (p=0.611).
• Patients in G2 who regressed experienced a significant increase in Clinical Activity Score (p=0.027) and a trend towards increased proptosis (p=0.298) compared to G1.

Conclusions:

• While the overall rate of regression after eye surgery in TED patients treated with teprotumumab may not differ based on timing, later surgeries (≥180 days post-treatment) are associated with more severe regression.
• Patients undergoing surgery later may require more repeat teprotumumab courses or additional surgical procedures.
• These findings suggest a potential need for careful timing of surgical interventions in relation to teprotumumab therapy.