Efficacy, Safety, and Recurrence in Older Thyroid Eye Disease Patients Undergoing Teprotumumab Treatment

Increasing life expectancy and an aging population have preserved quality of life decisions into older adulthood, defined by some clinical standards as greater than 75 years of age. While teprotumumab may represent a breakthrough in the treatment of thyroid eye disease, the teprotumumab phase III trial included only 2 patients aged over 75. Four female patients between the ages of 78 and 86—of whom 3 completed 8 infusions and 1 completed 7 infusions before discontinuation—were included in our study with a mean initial Clinical Activity Score score of 5.5, subjective diplopia, and proptosis. All patients experienced reduction in Clinical Activity Score with teprotumumab treatment. Two patients were subjective diplopia responders. Of the 6 eyes with collected measurements, all demonstrated a ≥2 mm reduction in post-treatment Hertel measurements. Most common adverse events were hyperglycemia, dysgeusia, fatigue, and alopecia. One patient with diabetes experienced an A1C rise requiring insulin. One patient had recurrence with increasing proptosis and recurrence of diplopia.