Tepezza Effective in Geriatric TED Patients, but AE, Regression Rates Higher

While teprotumumab was found to be effective in reducing clinical activity score and proptosis in geriatric thyroid eye disease patients with short-term follow-up, recurrence was common and  one-third of subjects discontinued because of adverse effects. Photo:  Bobby Saenz, OD. Click image to enlarge. Teprotumumab has had a major impact on thyroid eye disease (TED) since its FDA approval in 2020, but it’s also been associated with some worrisome adverse events (AEs), which can include hyperglycemia, hearing impairment, muscle spasms and severe conditions such as inflammatory bowel disease, encephalopathy and diabetic ketoacidosis. These were identified in the drug’s pivotal FDA trials; however, those studies did not include very many elderly patients.In a recent study, researchers sought to evaluate the efficacy and safety of teprotumumab for the treatment of TED in geriatric patients and found that while it is effective in the short term, high rates of AEs were seen, warranting caution and selective use in an older population, notably patients 75 and older.This was a multicenter cohort study of 50 patients (40 women, 10 men) aged 75 and older with moderate-to-severe thyroid eye disease and at least one infusion of teprotumumab treated between 2020 and 2023 across 10 tertiary care institutions. Efficacy outcome measures included improvement in clinical activity score, proptosis and Gorman diplopia score. Safety outcome measures included adverse event incidence, onset and severity.Teprotumumab was effective in reducing clinical activity score and proptosis in the short term; however, a high rate of proptosis regression (62.5% at 2.5 years) and TED reactivation was observed, with 50% experiencing a reduction of more than 2mm.Geriatric patients also experienced higher rates of moderate and severe AEs compared with younger pop­ulations. The rate of serious adverse events that led to disabling activi­ties of daily living disruption in the geriatric cohort was 4.0%; however, the rate of moderate and severe events was 44%.Patients received an average of 6.9 infusions, with 34% discontinuing treatment due to adverse events—significantly higher than what previous studies found. However, the substantial risk of severe AEs, increased rates of treatment discontinuation and a 27.9% rate of disease reactivation “call for extreme caution when considering its use in geriatric patients, especially in light of the increased incidence of proptosis regres­sion over time,” the authors wrote in their paper for Ophthalmic Plastic and Reconstructive Surgery.The most common AEs were muscle cramps (42%), hearing impairment (38%) and hyperglycemia (36%). While most hyperglycemic AEs were mild or moderate, four patients had severe hyperglycemia, with three requiring hospitalizations. All four patients had preexisting dia­betes, and in three of these cases the hyperglycemia led to dis­continuation of teprotumumab. “Increasing age has already been identified as a risk factor for hyperglycemia with teprotumumab therapy,” the authors wrote in their paper. “Our current study suggests that, in addition, geriatric patients with diabetes are more susceptible to severe hyperglycemia with teprotumumab treatment.”The study also found that 10% of patients required hospitalization due to severe AEs.The high rates of adverse events, reactivation and proptosis regression over time warrant extreme caution, the authors concluded. “Future studies should explore whether a lower dose or fewer infusions of teprotumumab could maintain therapeutic efficacy while reducing AEs in the geriatric population.”Click here for the journal source. Ashish SS, Patcharaporn C, Suyoung C, et al. The efficacy and safety of teprotumumab in geriatrics patients: a multicenter study. Ophthalmol Plastic Recon Sur. September 9, 2025. [Epub ahead of print.] This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.