Abstract

CONTEXT: Graves orbitopathy (GO) or thyroid eye disease is a potentially sight-threatening and disfiguring autoimmune disease. Teprotumumab is a monoclonal antibody against the insulin-like growth factor-I receptor that was recently approved for GO treatment. Hyperglycemia is a recognized adverse event of teprotumumab, occurring in 10% of patients in two recent randomized controlled trials.OBJECTIVE: Our study aimed to report the incidence, severity, management, and longitudinal glycemic changes in patients treated with teprotumumab in an academic practice cohort.METHODS: This longitudinal, observational study included all consecutive patients treated with teprotumumab between March 2020 and May 2022 at one institution. Hemoglobin A1c was measured every 3-months.RESULTS: Forty-two patients with baseline normoglycemia (n=22), pre-diabetes (n=10), and diabetes (n=10) were followed for a mean of 47.5 weeks. Overall, HbA1c increased by 0.5% at 3-months. Least-square mean changes in HbA1c at 3 months were 1.3 (p<0.001), 0.7 (p=0.01), and 0.1 (p=0.41) in patients with diabetes, pre-diabetes, and normoglycemia, respectively. Twenty-two patients (52%) had hyperglycemia which was graded as mild, moderate, and life-threatening in 55%(12/22), 41%(9/22), and 5%(1/22) of cases, respectively. Age, pre-existing diabetes, and Hispanic and Asian race/ethnicity were significant risk factors for hyperglycemia. Among patients with hyperglycemia, 36.4% (8/22) returned to baseline glycemic status at last follow-up.CONCLUSIONS: While effective, teprotumumab carries a significant risk of hyperglycemia, especially in patients with diabetes. Hyperglycemia may persist after stopping teprotumumab. These findings underscore the importance of guidelines for screening and management of teprotumumab-related hyperglycemia.

View details for DOI 10.1210/clinem/dgac627

View details for PubMedID 36300333