Biologics a sport changer for administration of thyroid eye illness

CHICAGO — Biologics are a sport changer for the therapy of thyroid eye illness, based on one speaker on the American Academy of Ophthalmology assembly.

“Biologics are monoclonal antibodies targeting a specific antigen and hold the promise of selective disease modification — that’s efficacy with limited side effects,” Rona Z. Silkiss, MD, mentioned.

Rituximab was the primary biologic used for thyroid eye illness (TED), described in 2009. Tocilizumab adopted shortly after and was permitted in 2010 by the FDA for rheumatoid arthritis.

“But the world change in terms of biologics for TED was in 2017, when the results of teprotumumab were published,” Silkiss mentioned. “Teprotumumab is an IGF-1R receptor antagonist that blocks the TSHR/IGF-1R coactivation by [thyroid-stimulating immunoglobulin] and, consequently, the induction of proinflammatory cytokines. In 2020, teprotumumab was FDA approved for the treatment of active TED with impressive results, especially with respect to proptosis, and has also been studied for the treatment of recurrent and chronic TED.”

However, as a result of the IGF-1R receptor is expressed in nearly each cell of the physique, the systemic administration of this drug has many potential uncomfortable side effects, together with listening to loss, dysmenorrhea, muscle spasm, hair loss and ulcerative colitis. In addition, there generally is a excessive recurrence charge. The price of teprotumumab can also be excessive, nearly $150,000 per mm of proptosis discount.

However, “these three drugs are just the beginning of the story, and more biologics are already in the pipeline, with different mechanisms of action,” Silkiss mentioned. “We are looking for drugs that are modifiers of the disease but have minimum side effects and are easy to administer also early in the course of the disease to prevent chronic stigmata and make chronic disease extinct. We also want them cost-effective to limit the financial burden and increase access.”