|
1
|
Ting MA, Ozzello DJ, Topilow NJ, Yoon JS, Liu CY, Korn BS, Kikkawa DO. Differential effects of teprotumumab treatment based on fat-to-muscle ratio in patients with thyroid eye disease. Orbit 2022:1-8. [PMID: 36097675 DOI: 10.1080/01676830.2022.2122515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE To characterize the distribution of fat-to-muscle ratio (FMR) across patients with thyroid eye disease (TED) and to assess the association between FMR and therapeutic response to teprotumumab. METHODS A retrospective cohort study of patients completing a full course of teprotumumab for TED between January 2020 and March 2022 at a single tertiary referral center. Patients without baseline orbital imaging were excluded. Quantitative analysis of FMR was performed by manual segmentation of patients' imaging using OsiriX software. The primary outcome measure was change in clinical measurement of proptosis. Linear regression modelled change in proptosis against FMR. Statistical significance was set at p < .05. RESULTS Twenty-two patients (3 M:19F) were included with a mean age of 49.4 ± 15.5 years. The FMR ranged from 1.11 to 6.54, mean 3.15 ± 1.30. The data did not deviate from a normal distribution (Shapiro-Wilk test for normality, p = .18). Pre- and post-treatment average proptosis measurements were 21.72 ± 3.56 mm and 18.81 ± 3.07 mm, respectively. Univariable linear regression demonstrated a 0.78 ± 0.36 mm greater reduction in proptosis for every 1 unit decrease in FMR (p = .038). CONCLUSIONS Contrary to the traditional dichotomous characterization of TED into type 1 and type 2 phenotypes, orbital FMR may represent a continuum of disease manifestation, more closely following a normal rather than bimodal distribution. Furthermore, pre-treatment FMR is associated with response to teprotumumab; those with lower FMR experiencing a greater reduction in proptosis. This has implications for patient selection and counselling regarding the expected treatment outcome.
Collapse
Affiliation(s)
- Michelle A Ting
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
| | - Daniel James Ozzello
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
| | - Nicole J Topilow
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
| | - Jin Sook Yoon
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, USA.,Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
| | - Catherine Y Liu
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
| | - Bobby S Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, USA.,Division of Plastic and Reconstructive Surgery, Department of Surgery, UC San Diego, La Jolla, California, USA
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, USA.,Division of Plastic and Reconstructive Surgery, Department of Surgery, UC San Diego, La Jolla, California, USA
| |
Collapse
|
|
2
|
Kang J, Lechuga M, Braun J, Kossler A, Douglas R, Cockerham K. Infusion Center Guidelines for Teprotumumab Infusions: Informed Consent, Safety, and Management of Side Effects. JOURNAL OF INFUSION NURSING 2021; 44:331-338. [PMID: 34753152 PMCID: PMC10853843 DOI: 10.1097/nan.0000000000000446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Teprotumumab was the first and only medication approved by the US Food and Drug Administration for the treatment of thyroid eye disease in January 2020. Thyroid eye disease is a complex autoimmune inflammatory disease that can be sight-threatening, debilitating, and disfiguring to affected patients. Although biologic therapies are a preferred treatment option for many complex immunologic and oncologic conditions, their use in ophthalmology and endocrinology may be more novel. The goals of this article are to introduce this new therapeutic option; discuss its mechanism of action, indications for use, administration protocol, infusion precautions, and informed consent; and review common side effects and management.
Collapse
Affiliation(s)
- Julia Kang
- Central Valley Eye Medical Group; Stockton, California (Drs Kang and Cockerham); Private Practice, Beverly Hills, California (Mss Lechuga and Braun and Dr Douglas); Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Drs Kossler and Cockerham)
- Julia Kang, MD, MPH, is a board-certified ophthalmologist who completed her residency training at the Emory Eye Center. She is currently in fellowship training for oculoplastic and reconstructive surgery. She has coauthored multiple peer-reviewed publications and, as an artist, she has contributed medical illustrations for oculoplastic surgery book chapters. After fellowship training, she will be returning to Atlanta, Georgia, to join a private practice group
- Maria Lechuga, BSN, RN, has been a registered nurse and an infusion nurse for more than a decade. She has been running Dr Raymond Douglas's infusion center for the past 2 years. She is currently pursuing her nurse practitioner education and certification
- Jenna Braun, BS, is a clinical research coordinator for Raymond Douglas, MD, PhD. She received her Bachelor of Science degree in neurobiology at the University of Wisconsin and has worked as a clinical research coordinator for 1 year
- Andrea Kossler, MD, is a board-certified ophthalmologist with fellowship training in orbital disease and oculoplastic reconstruction. She has been caring for thyroid eye disease patients for more than a decade. She is an assistant professor in the Stanford Department of Ophthalmology. She has published more than 100 peer-reviewed articles and lectures on thyroid eye disease nationally and internationally
- Raymond Douglas, MD, PhD, is an experienced board-certified aesthetic and reconstructive oculoplastic specialist. Patients with thyroid eye disease, Graves' eye disease, previous unsuccessful surgery, cancers of the eyelids or face, and trauma-induced injuries seek Dr Douglas's expert, customized care at both his primary practice in Beverly Hills and international practice, LA Face, in Shanghai, China. His expertise in treating difficult cases of disfigurement attributed to thyroid-associated eye diseases and cosmetic and reconstruction surgeries has made him a highly respected educational and surgical authority for both reconstructive and cosmetics arts of facial plastics
- Kimberly Cockerham, MD, FACS, is a board-certified ophthalmologist with fellowship training in neuro-ophthalmology, orbital disease, and oculoplastic reconstruction. She has been caring for patients with thyroid eye disease for several decades. She is currently an adjunct clinical associate professor in the Stanford Department of Ophthalmology. Dr Cockerham was previously chief of orbital disease and oculoplastic surgery at University of California San Francisco and Walter Reed Army Medical Center. She has published more than 100 peer-reviewed articles, coauthored a book on orbital disease diagnosis and management, and lectures on thyroid eye disease nationally and internationally
| | - Maria Lechuga
- Central Valley Eye Medical Group; Stockton, California (Drs Kang and Cockerham); Private Practice, Beverly Hills, California (Mss Lechuga and Braun and Dr Douglas); Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Drs Kossler and Cockerham)
- Julia Kang, MD, MPH, is a board-certified ophthalmologist who completed her residency training at the Emory Eye Center. She is currently in fellowship training for oculoplastic and reconstructive surgery. She has coauthored multiple peer-reviewed publications and, as an artist, she has contributed medical illustrations for oculoplastic surgery book chapters. After fellowship training, she will be returning to Atlanta, Georgia, to join a private practice group
- Maria Lechuga, BSN, RN, has been a registered nurse and an infusion nurse for more than a decade. She has been running Dr Raymond Douglas's infusion center for the past 2 years. She is currently pursuing her nurse practitioner education and certification
- Jenna Braun, BS, is a clinical research coordinator for Raymond Douglas, MD, PhD. She received her Bachelor of Science degree in neurobiology at the University of Wisconsin and has worked as a clinical research coordinator for 1 year
- Andrea Kossler, MD, is a board-certified ophthalmologist with fellowship training in orbital disease and oculoplastic reconstruction. She has been caring for thyroid eye disease patients for more than a decade. She is an assistant professor in the Stanford Department of Ophthalmology. She has published more than 100 peer-reviewed articles and lectures on thyroid eye disease nationally and internationally
- Raymond Douglas, MD, PhD, is an experienced board-certified aesthetic and reconstructive oculoplastic specialist. Patients with thyroid eye disease, Graves' eye disease, previous unsuccessful surgery, cancers of the eyelids or face, and trauma-induced injuries seek Dr Douglas's expert, customized care at both his primary practice in Beverly Hills and international practice, LA Face, in Shanghai, China. His expertise in treating difficult cases of disfigurement attributed to thyroid-associated eye diseases and cosmetic and reconstruction surgeries has made him a highly respected educational and surgical authority for both reconstructive and cosmetics arts of facial plastics
- Kimberly Cockerham, MD, FACS, is a board-certified ophthalmologist with fellowship training in neuro-ophthalmology, orbital disease, and oculoplastic reconstruction. She has been caring for patients with thyroid eye disease for several decades. She is currently an adjunct clinical associate professor in the Stanford Department of Ophthalmology. Dr Cockerham was previously chief of orbital disease and oculoplastic surgery at University of California San Francisco and Walter Reed Army Medical Center. She has published more than 100 peer-reviewed articles, coauthored a book on orbital disease diagnosis and management, and lectures on thyroid eye disease nationally and internationally
| | - Jenna Braun
- Central Valley Eye Medical Group; Stockton, California (Drs Kang and Cockerham); Private Practice, Beverly Hills, California (Mss Lechuga and Braun and Dr Douglas); Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Drs Kossler and Cockerham)
- Julia Kang, MD, MPH, is a board-certified ophthalmologist who completed her residency training at the Emory Eye Center. She is currently in fellowship training for oculoplastic and reconstructive surgery. She has coauthored multiple peer-reviewed publications and, as an artist, she has contributed medical illustrations for oculoplastic surgery book chapters. After fellowship training, she will be returning to Atlanta, Georgia, to join a private practice group
- Maria Lechuga, BSN, RN, has been a registered nurse and an infusion nurse for more than a decade. She has been running Dr Raymond Douglas's infusion center for the past 2 years. She is currently pursuing her nurse practitioner education and certification
- Jenna Braun, BS, is a clinical research coordinator for Raymond Douglas, MD, PhD. She received her Bachelor of Science degree in neurobiology at the University of Wisconsin and has worked as a clinical research coordinator for 1 year
- Andrea Kossler, MD, is a board-certified ophthalmologist with fellowship training in orbital disease and oculoplastic reconstruction. She has been caring for thyroid eye disease patients for more than a decade. She is an assistant professor in the Stanford Department of Ophthalmology. She has published more than 100 peer-reviewed articles and lectures on thyroid eye disease nationally and internationally
- Raymond Douglas, MD, PhD, is an experienced board-certified aesthetic and reconstructive oculoplastic specialist. Patients with thyroid eye disease, Graves' eye disease, previous unsuccessful surgery, cancers of the eyelids or face, and trauma-induced injuries seek Dr Douglas's expert, customized care at both his primary practice in Beverly Hills and international practice, LA Face, in Shanghai, China. His expertise in treating difficult cases of disfigurement attributed to thyroid-associated eye diseases and cosmetic and reconstruction surgeries has made him a highly respected educational and surgical authority for both reconstructive and cosmetics arts of facial plastics
- Kimberly Cockerham, MD, FACS, is a board-certified ophthalmologist with fellowship training in neuro-ophthalmology, orbital disease, and oculoplastic reconstruction. She has been caring for patients with thyroid eye disease for several decades. She is currently an adjunct clinical associate professor in the Stanford Department of Ophthalmology. Dr Cockerham was previously chief of orbital disease and oculoplastic surgery at University of California San Francisco and Walter Reed Army Medical Center. She has published more than 100 peer-reviewed articles, coauthored a book on orbital disease diagnosis and management, and lectures on thyroid eye disease nationally and internationally
| | - Andrea Kossler
- Central Valley Eye Medical Group; Stockton, California (Drs Kang and Cockerham); Private Practice, Beverly Hills, California (Mss Lechuga and Braun and Dr Douglas); Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Drs Kossler and Cockerham)
- Julia Kang, MD, MPH, is a board-certified ophthalmologist who completed her residency training at the Emory Eye Center. She is currently in fellowship training for oculoplastic and reconstructive surgery. She has coauthored multiple peer-reviewed publications and, as an artist, she has contributed medical illustrations for oculoplastic surgery book chapters. After fellowship training, she will be returning to Atlanta, Georgia, to join a private practice group
- Maria Lechuga, BSN, RN, has been a registered nurse and an infusion nurse for more than a decade. She has been running Dr Raymond Douglas's infusion center for the past 2 years. She is currently pursuing her nurse practitioner education and certification
- Jenna Braun, BS, is a clinical research coordinator for Raymond Douglas, MD, PhD. She received her Bachelor of Science degree in neurobiology at the University of Wisconsin and has worked as a clinical research coordinator for 1 year
- Andrea Kossler, MD, is a board-certified ophthalmologist with fellowship training in orbital disease and oculoplastic reconstruction. She has been caring for thyroid eye disease patients for more than a decade. She is an assistant professor in the Stanford Department of Ophthalmology. She has published more than 100 peer-reviewed articles and lectures on thyroid eye disease nationally and internationally
- Raymond Douglas, MD, PhD, is an experienced board-certified aesthetic and reconstructive oculoplastic specialist. Patients with thyroid eye disease, Graves' eye disease, previous unsuccessful surgery, cancers of the eyelids or face, and trauma-induced injuries seek Dr Douglas's expert, customized care at both his primary practice in Beverly Hills and international practice, LA Face, in Shanghai, China. His expertise in treating difficult cases of disfigurement attributed to thyroid-associated eye diseases and cosmetic and reconstruction surgeries has made him a highly respected educational and surgical authority for both reconstructive and cosmetics arts of facial plastics
- Kimberly Cockerham, MD, FACS, is a board-certified ophthalmologist with fellowship training in neuro-ophthalmology, orbital disease, and oculoplastic reconstruction. She has been caring for patients with thyroid eye disease for several decades. She is currently an adjunct clinical associate professor in the Stanford Department of Ophthalmology. Dr Cockerham was previously chief of orbital disease and oculoplastic surgery at University of California San Francisco and Walter Reed Army Medical Center. She has published more than 100 peer-reviewed articles, coauthored a book on orbital disease diagnosis and management, and lectures on thyroid eye disease nationally and internationally
| | - Raymond Douglas
- Central Valley Eye Medical Group; Stockton, California (Drs Kang and Cockerham); Private Practice, Beverly Hills, California (Mss Lechuga and Braun and Dr Douglas); Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Drs Kossler and Cockerham)
- Julia Kang, MD, MPH, is a board-certified ophthalmologist who completed her residency training at the Emory Eye Center. She is currently in fellowship training for oculoplastic and reconstructive surgery. She has coauthored multiple peer-reviewed publications and, as an artist, she has contributed medical illustrations for oculoplastic surgery book chapters. After fellowship training, she will be returning to Atlanta, Georgia, to join a private practice group
- Maria Lechuga, BSN, RN, has been a registered nurse and an infusion nurse for more than a decade. She has been running Dr Raymond Douglas's infusion center for the past 2 years. She is currently pursuing her nurse practitioner education and certification
- Jenna Braun, BS, is a clinical research coordinator for Raymond Douglas, MD, PhD. She received her Bachelor of Science degree in neurobiology at the University of Wisconsin and has worked as a clinical research coordinator for 1 year
- Andrea Kossler, MD, is a board-certified ophthalmologist with fellowship training in orbital disease and oculoplastic reconstruction. She has been caring for thyroid eye disease patients for more than a decade. She is an assistant professor in the Stanford Department of Ophthalmology. She has published more than 100 peer-reviewed articles and lectures on thyroid eye disease nationally and internationally
- Raymond Douglas, MD, PhD, is an experienced board-certified aesthetic and reconstructive oculoplastic specialist. Patients with thyroid eye disease, Graves' eye disease, previous unsuccessful surgery, cancers of the eyelids or face, and trauma-induced injuries seek Dr Douglas's expert, customized care at both his primary practice in Beverly Hills and international practice, LA Face, in Shanghai, China. His expertise in treating difficult cases of disfigurement attributed to thyroid-associated eye diseases and cosmetic and reconstruction surgeries has made him a highly respected educational and surgical authority for both reconstructive and cosmetics arts of facial plastics
- Kimberly Cockerham, MD, FACS, is a board-certified ophthalmologist with fellowship training in neuro-ophthalmology, orbital disease, and oculoplastic reconstruction. She has been caring for patients with thyroid eye disease for several decades. She is currently an adjunct clinical associate professor in the Stanford Department of Ophthalmology. Dr Cockerham was previously chief of orbital disease and oculoplastic surgery at University of California San Francisco and Walter Reed Army Medical Center. She has published more than 100 peer-reviewed articles, coauthored a book on orbital disease diagnosis and management, and lectures on thyroid eye disease nationally and internationally
| | - Kimberly Cockerham
- Central Valley Eye Medical Group; Stockton, California (Drs Kang and Cockerham); Private Practice, Beverly Hills, California (Mss Lechuga and Braun and Dr Douglas); Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Drs Kossler and Cockerham)
- Julia Kang, MD, MPH, is a board-certified ophthalmologist who completed her residency training at the Emory Eye Center. She is currently in fellowship training for oculoplastic and reconstructive surgery. She has coauthored multiple peer-reviewed publications and, as an artist, she has contributed medical illustrations for oculoplastic surgery book chapters. After fellowship training, she will be returning to Atlanta, Georgia, to join a private practice group
- Maria Lechuga, BSN, RN, has been a registered nurse and an infusion nurse for more than a decade. She has been running Dr Raymond Douglas's infusion center for the past 2 years. She is currently pursuing her nurse practitioner education and certification
- Jenna Braun, BS, is a clinical research coordinator for Raymond Douglas, MD, PhD. She received her Bachelor of Science degree in neurobiology at the University of Wisconsin and has worked as a clinical research coordinator for 1 year
- Andrea Kossler, MD, is a board-certified ophthalmologist with fellowship training in orbital disease and oculoplastic reconstruction. She has been caring for thyroid eye disease patients for more than a decade. She is an assistant professor in the Stanford Department of Ophthalmology. She has published more than 100 peer-reviewed articles and lectures on thyroid eye disease nationally and internationally
- Raymond Douglas, MD, PhD, is an experienced board-certified aesthetic and reconstructive oculoplastic specialist. Patients with thyroid eye disease, Graves' eye disease, previous unsuccessful surgery, cancers of the eyelids or face, and trauma-induced injuries seek Dr Douglas's expert, customized care at both his primary practice in Beverly Hills and international practice, LA Face, in Shanghai, China. His expertise in treating difficult cases of disfigurement attributed to thyroid-associated eye diseases and cosmetic and reconstruction surgeries has made him a highly respected educational and surgical authority for both reconstructive and cosmetics arts of facial plastics
- Kimberly Cockerham, MD, FACS, is a board-certified ophthalmologist with fellowship training in neuro-ophthalmology, orbital disease, and oculoplastic reconstruction. She has been caring for patients with thyroid eye disease for several decades. She is currently an adjunct clinical associate professor in the Stanford Department of Ophthalmology. Dr Cockerham was previously chief of orbital disease and oculoplastic surgery at University of California San Francisco and Walter Reed Army Medical Center. She has published more than 100 peer-reviewed articles, coauthored a book on orbital disease diagnosis and management, and lectures on thyroid eye disease nationally and internationally
| |
Collapse
|