Otologic Symptoms in Patients Treated With Teprotumumab: A Multi‐Institutional National Cohort Study

OBJECTIVES: Teprotumumab is a monoclonal antibody introduced in 2020 to treat thyroid eye disease (TED) with potential adverse effects on the cochlea and fat tissue around the eustachian tube. This study investigates the incidence and odds of developing hearing loss and tinnitus associated with Teprotumumab. METHODS: TriNetX, a multi-institutional database, was queried for U.S. adults (≥ 18 years) with TED. Patients who were and were not prescribed Teprotumumab were matched using a propensity score by demographics and comorbidities. Outcomes were queried based on ICD-10 codes for sensorineural hearing loss (SNHL) and tinnitus. Odds ratios (OR) were calculated in TriNetX. RESULTS: A total of 947 TED patients used Teprotumumab (mean [S.D.] age 56.4 [14.7]) while 258 520 TED patients did not (age 48.4 [17.6]). After propensity score matching, each analytic cohort included 947 patients. At a mean follow-up of 28.6 (18.2) months (S.D.) for the Teprotumumab group and 26.8 (21.3) months (S.D.) for the non-use group, the incidence of SNHL was 10.0% and 3.7%, respectively. Tinnitus incidence rates were 5.6% in the Teprotumumab group and 1.8% in the non-use group. TED patients treated with Teprotumumab demonstrated higher odds of SNHL (OR, 2.89; 95% CI:1.92-4.36) and tinnitus (OR, 3.13; 95% CI:1.79-5.46) compared to TED patients not treated with Teprotumumab. CONCLUSION: Teprotumumab use is significantly associated with the development of SNHL and tinnitus among TED patients. Patients receiving Teprotumumab should be monitored for otologic outcomes to avoid possible irreversible damage. Further research is needed to establish clinical guidelines for standardized monitoring and treatment adjustment protocols.