When Is Teprotumumab Used to Treat TED?
For moderate to severe TED, teprotumumab may be one part of a multipronged approach to treatment.
Depending on your symptoms, Tagg says care may also include:
- Treatment for dry eyes, irritation, or exposure symptoms
- Smoking cessation, because smoking is linked with worse TED
- Prisms or surgery for strabismus, or eye misalignment
- Surgery if pressure on the optic nerve threatens vision
- Ongoing care from both an ophthalmologist and an endocrinologist
“We generally don’t select more than one medication-based treatment at a time,” says Tagg, meaning your doctor may weigh teprotumumab against other medication options instead of adding it on top of another systemic TED drug.
The decision depends on how active the disease is, how severe the symptoms are, whether vision is at risk, what treatments have already been tried, and which side effects are most concerning for you, he says.
When Tagg talks with patients about teprotumumab, he frames both the possible benefits and the risks.
Teprotumumab can be expected to calm the inflammatory response in the orbit and help shrink inflamed tissues, he says. “This leads to decreased proptosis, increased comfort, and in some cases decreased double vision or vision loss.”
The risks need careful discussion, especially hearing changes. “There is a real risk of hearing loss, probably on the order of 10 to 25 percent, and this hearing loss can sometimes be permanent.”
For that reason, Tagg says he is hesitant to use teprotumumab in someone who already has hearing loss. Teprotumumab can also make diabetes harder to treat and cause painful muscle cramping, he says.
Before starting treatment, ask what monitoring you need, especially if you have diabetes, prediabetes, hearing problems, inflammatory bowel disease, or could become pregnant.
