Demographic disparities in teprotumumab use for thyroid eye disease in the United States

To compare race, sex, and ethnicity of thyroid eye disease patients who were and were not prescribed teprotumumab.

This retrospective, comparative study used TriNetX health record database to compare race, sex, and ethnicity distributions between patients who were and were not prescribed teprotumumab from 2020 to 2025. Patients with at least one thyroid eye disease sign (exophthalmos, eyelid retraction, strabismus) and elevated thyroid stimulating immunoglobulin (≥1.30 index value) were included. Subanalysis examining 2020-2023 and 2023-2025 periods was conducted.

There were 293 patients prescribed teprotumumab and 4125 controls. Significant racial disparities existed between controls and teprotumumab patients (χ² = 25.1414, p < 0.0001). Odds of White patients receiving teprotumumab were 2.52 (99% CI: 1.51-4.21) times higher than Black patients but not significantly different from patients of other races. Subanalysis showed significant racial disparities from 2020 to 2023 (χ² = 23.5221, p < 0.0001), but these differences were not statistically significant from 2023 to 2025 (χ² = 4.0007, p = 0.1353). No significant ethnic- or sex-based disparities were found.

White patients were disproportionately more likely to be prescribed teprotumumab than Black patients, potentially due to prescriber bias, socioeconomic challenges, and medical distrust. Trends show progress towards more equitable distribution.