INDIRECT TREATMENT COMPARISON OF TEPROTUMUMAB VS RITUXIMAB OR TOCILIZUMAB IN PATIENTS WITH MODERATE-TO-SEVERE ACTIVE THYROID EYE DISEASE
Author(s)
Alexandra Eddy, MSc1, Yu Wang, PhD2, Tommy Lan, MS2, Yuting Kuang, PhD2, Christina Giannopoulou, MD3;
1Amgen, Thousand Oaks, CA, USA, 2IQVIA, Inc., San Francisco, CA, USA, 3Amgen (Europe) GmbH, Rotkreuz, Switzerland
1Amgen, Thousand Oaks, CA, USA, 2IQVIA, Inc., San Francisco, CA, USA, 3Amgen (Europe) GmbH, Rotkreuz, Switzerland
OBJECTIVES: The American and European Thyroid Association (ATA/ETA) guidelines note that rituximab and tocilizumab may be considered for glucocorticoid-resistant active thyroid eye disease (TED). Teprotumumab is the only approved treatment for TED and is recommended by the ATA for patients with significant diplopia or proptosis. Given the limited availability of head-to-head data, this study employed indirect treatment comparison (ITC) methods to evaluate the relative efficacy of teprotumumab versus rituximab and tocilizumab in moderate-to-severe active TED.
METHODS: Data for ITC included individual patient data from two teprotumumab randomized controlled trials (RCT), and aggregate data from one rituximab RCT and six tocilizumab studies (1 RCT and 5 real-world evidence studies), identified through systematic review and feasibility assessment. To adjust for population differences, an anchored matching-adjusted indirect comparison (MAIC) was performed for teprotumumab vs rituximab, and an unanchored MAIC for teprotumumab vs tocilizumab. Mean difference in change from baseline in proptosis and odds ratio (OR) for diplopia response (≥1 grade reduction from baseline) were estimated after adjusting for smoking status, prior radioactive iodine therapy (tocilizumab analysis only), baseline proptosis, baseline diplopia, age, and sex.
RESULTS: Teprotumumab was associated with a greater reduction in proptosis compared with rituximab (mean difference [95% CI]: -3.65 mm [-5.07, -2.23]), and tocilizumab (-1.20 mm [-2.07, -0.32]). Diplopia response rates were higher for teprotumumab vs rituximab (OR [95% CI]: 38.95 [3.24, 468.28]); this large OR reflected the substantial variance due to no diplopia responses in the rituximab arm (continuity correction applied). Compared to tocilizumab, teprotumumab showed higher odds of diplopia response (OR: 2.55 [0.52, 12.43]), though interpretation was limited by geographic differences and small effective sample size.
CONCLUSIONS: Teprotumumab demonstrated greater reductions in proptosis and improvements in diplopia compared with rituximab and tocilizumab. These findings support teprotumumab as an effective treatment option for pre-treated patients with moderate-to-severe active TED.
METHODS: Data for ITC included individual patient data from two teprotumumab randomized controlled trials (RCT), and aggregate data from one rituximab RCT and six tocilizumab studies (1 RCT and 5 real-world evidence studies), identified through systematic review and feasibility assessment. To adjust for population differences, an anchored matching-adjusted indirect comparison (MAIC) was performed for teprotumumab vs rituximab, and an unanchored MAIC for teprotumumab vs tocilizumab. Mean difference in change from baseline in proptosis and odds ratio (OR) for diplopia response (≥1 grade reduction from baseline) were estimated after adjusting for smoking status, prior radioactive iodine therapy (tocilizumab analysis only), baseline proptosis, baseline diplopia, age, and sex.
RESULTS: Teprotumumab was associated with a greater reduction in proptosis compared with rituximab (mean difference [95% CI]: -3.65 mm [-5.07, -2.23]), and tocilizumab (-1.20 mm [-2.07, -0.32]). Diplopia response rates were higher for teprotumumab vs rituximab (OR [95% CI]: 38.95 [3.24, 468.28]); this large OR reflected the substantial variance due to no diplopia responses in the rituximab arm (continuity correction applied). Compared to tocilizumab, teprotumumab showed higher odds of diplopia response (OR: 2.55 [0.52, 12.43]), though interpretation was limited by geographic differences and small effective sample size.
CONCLUSIONS: Teprotumumab demonstrated greater reductions in proptosis and improvements in diplopia compared with rituximab and tocilizumab. These findings support teprotumumab as an effective treatment option for pre-treated patients with moderate-to-severe active TED.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
CO73
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity), SDC: Rare & Orphan Diseases, SDC: Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)