Dr Shoaib Ugradar Addresses Presenting Patients With Treatment Options and Informing Them About AEs

While teprotumumab, a new FDA-approved therapy for thyroid eye disease (TED), has its adverse events, the other options to treat TED can have severe consequences, said Shoaib Ugradar, MD, UCLA Stein Eye Center Santa Monica.


Teprotumumab is the first approved therapy for thyroid eye disease, but it’s not without a list of adverse events (AEs). Could the potential AEs be enough to discourage some eligible patients from taking the drug?

I think to frame the answer, I’d like to just put things into a bit of context. So, at the moment, teprotumumab is the only therapy that specifically targets the pathogenesis of thyroid eye disease—ie, the overexpression of the IGF-1 [insulin-like growth factor type 1] receptor. And we know this is the cause of, or contributes significantly to the cause of, inflammation and soft tissue expansion in patients with thyroid eye disease.

Other modalities, such as, you know, steroids, other biologic agents, or even surgery, for example, decompression, are only measures aimed at alleviating the consequences of thyroid eye disease. They do not target the central mechanism that causes it.

Now, I’ll just tell you a brief story about a patient I saw the other day. I saw a 31-year-old actress who came in, and she’d been to see somebody else who suggested orbital decompression surgery for her proptosis. And she came in and she said, “My face is swollen, I have bad proptosis. And I want something done but I don’t want somebody doing major surgery on me; for example, using a drill behind my eyes.” And I explained to her that, you know, in most cases, orbital decompression surgery is very safe and effective. And she came back, and she had done her research and she said, “You know, a third of patients might wake up with new onset or worsening double vision. And they may have disfiguring effects,” etc, etc.

And, you know, it’s very difficult to address some of these questions. And sometimes you have to give the patient the right to choose. And in my experience, you know, patients are well informed about the adverse events related to teprotumumab. But they also know about some of the severe consequences of having, you know, decompression surgery or using steroids or orbital radiation. And a lot of patients, in my experience, choose to go down the route of teprotumumab. Especially because a lot of the therapies that I’ve mentioned don’t address things like facial swelling. Teprotumumab, to my mind, is the only medication like I’ve presented this week [at the November 2021 American Society of Ophthalmic Plastic & Reconstructive Surgery meeting] to actually address facial swelling and soft tissue enlargement across the lower half of the face. Other medications or surgical management just don’t achieve that.

So, you know, we always leave it—we present the information to patients and allow them to make an informed decision. But in my experience, most patients typically go down the way of teprotumumab.

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