by Paul Batson, O.D. Center Director VisionAmerica of Birmingham I recently had an opportunity to speak at SECO and share some thoughts on a variety of interesting cases. One of the patients that I presented had Graves' Disease. The point of the case was to share some interesting information about Teprotumumab, a new treatment that is beginning phase three trials and may have the potential to completely eliminate the need for orbital decompression. I thought I would share a little more information about this exciting new treatment that is currently in the pipeline. Teprotumumab is a monoclonal antibody which targets insulin growth factor-1 receptors (IGF-1R). Originally developed for the treatment of breast cancer and lymphoma (Hodgkin and Non-Hodgkin), the results were not as promising as originally thought. Subsequently, the studies for these diseases stopped. We know that Graves' disease patients have an over-expression of IGF-1R which can lead to increased inflammation and secondary ophthalmopathy causing proptosis, diplopia and eventually reduced vision in patients experiencing compressive optic neuropathy. Due to the receptor binding properties of Teprotumumab, we're seeing improvement in patients undergoing treatment. The results of the initial trials were published last year in the New England Journal of Medicine. To read the complete study, click here. Below is a brief summary of some of the key points: Who is treated? Patients with moderate to severe Graves' ophthalmopathy. How is the treatment given? It is given by infusion once every three weeks for eight treatments (24 weeks). What are the side effects? The primary side effect was hyperglycemia and was predominantly seen in patients with pre-existing diabetes. What are the results? A nearly 2.5 mm reduction in proptosis over the 24 week period vs. .15 mm reduction in the placebo group. Also, the treatment group saw a decrease in diplopia as well as improved Quality of Life (QOL) scores for vision functioning and appearance. Initial results seem to show that Teprotumumab offers a dramatic improvement in a large number of moderate to severe Graves' ophthalmopathy patients with minimal side effects. If the results continue in phase 3 trials, this could dramatically reduce the number of orbital decompression, strabismus and eyelid surgeries required for these patients.
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August 2019
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