The Efficacy and Safety of Teprotumumab in Geriatrics Patients: A Multicenter Study

Purpose: To evaluate the efficacy and safety of teprotumumab for the treatment of thyroid eye disease in geriatric patients. Methods: This was a multicenter cohort study of patients aged 75 and older, treated between February 2020 and September 2023 across 10 tertiary institutions. Patients were included if they had moderate-to-severe thyroid eye disease and at least 1 infusion of teprotumumab. Efficacy outcome measures included improvement in clinical activity score, proptosis, and Gorman diplopia score. Safety outcome measures included teprotumumab-related adverse event (TAE) incidence, onset, and severity. Results: Fifty patients (40 females, 10 males), average age of 79.2 years, were evaluated. Patients received an average of 6.9 infusions, with 34.0% (17/50) discontinuing treatment due to TAEs. Mean baseline clinical activity score was 4.0 ± 1.6, with a mean reduction of 4.0 ± 1.1. Proptosis improved by ≥2 mm in 86.0% (43/50) of patients, with a mean reduction of 4.24 mm. Of patients with baseline diplopia, 42.9% (18/42) experienced an improvement in Gorman diplopia score. Proptosis regression occurred in 62.5% (15/24) of patients at 2.5 years, and 27.9% (12/43) experienced thyroid eye disease reactivation on average 49.8 weeks posttreatment completion. TAEs were reported by 78.0% (39/50) of patients, with 30% (15/46) experiencing moderate TAEs and 14% (7/50) severe TAEs. The most common TAEs were muscle cramps (42.0%, 21/50), hearing impairment (38.0%, 19/46), and hyperglycemia (36.0%, 18/46). Conclusions: Teprotumumab is effective in reducing clinical activity score and proptosis in geriatric thyroid eye disease patients with short-term follow-up; however, high rates of adverse events, reactivation, and proptosis regression over time warrant extreme caution and selective use in this population.