(1171) Evaluation of Teprotumumab for Treatment of Thyroid Eye Disease Across a Large, Rural Health System

Objectives: Teprotumumab (Tepezza) is the first, and only, FDA-approved medication indicated for the treatment of Thyroid Eye Disease (TED). Due to its intravenous administration, high cost, and safety concerns, it’s imperative to ensure appropriate utilization. Teprotumumab has warnings for exacerbations of inflammatory bowel disease, infusion reactions, hyperglycemia, and a newly FDA added warning for hearing impairment including hearing loss. In order to provide the best care for patients, access to and the cost of treatment are important components to consider. This medication use evaluation strived to characterize the use of teprotumumab across the West Virginia University Health System (WVUHS).

Methods: This medication use evaluation was a retrospective chart review utilizing electronic medical records of patients in the WVUHS that received or are receiving teprotumumab. Patients included in the review were at least 18 years of age and received at least one dose of teprotumumab in the outpatient setting at any facility throughout WVUHS from November 2021 through August 2023. Patient demographics were collected, including age, sex, race, insurance provider, institution where teprotumumab was administered, previously attempted treatments, proptosis measurements, and if the patient had a diagnosis of inflammatory bowel disease (IBD) or diabetes. Information was also collected specific to each administration that included dose, number of vials of medication used, infusion duration, number of infusions completed, heart rate, blood pressure, blood glucose, days between doses, patient’s weight on day of infusion, if any pre-medications were delivered, and any infusion-related reactions.

Results: Forty-five patients were identified with a total of 315 administrations including 87% female, ranging between 18 to 83 with a median of 56 years of age. 69% of patients received the full course of treatment (8 infusions), and 27% of patients either did not complete the course or are in the process of completing it. Due to unavailable information of proptosis measurements, no results were yielded to determine efficacy of teprotumumab. No patients had a concurrent IBD diagnosis, and 9% of patients had a concurrent diabetes diagnosis. Previously attempted treatments included 7% treated with intravenous methylprednisolone and 2% received orbital decompression surgery. All patients had their blood glucose levels checked and tested for pregnancy, if applicable, prior to their treatment to confirm eligibility for treatment. 16% of patients experienced infusion-related reactions; however, 24% of patients received pre-medications prior to their infusions despite only being indicated in patients who previously experienced a reaction. One patient reported hearing loss and one patient had measured hearing loss. It was found that 38% of administrations were incorrectly dosed based on the patients’ weight, and 37% of administrations did not have an updated weight on the day of their infusion to determine the correct dosing.

Conclusions: This medication use evaluation solidified the opportunity to improve teprotumumab use within the WVUHS. Safety concerns are important aspects of a patient’s treatment. Data collection determined that proper weight-based dosing is not being adhered to and resulted in the need to standardize documentation practices across the health system. The use of pre-medications should be reserved for the patients who have previously exhibited an infusion-related reaction. The appropriate use of EPIC therapy plans to document and monitor adverse effects are warranted. With optimization of use of teprotumumab, there are cost savings opportunities for both the patient and health care systems.