Presentation (CTI)

OBJECTIVES: To assess UK clinical expert perspectives on the positioning of teprotumumab for active moderate-to-severe thyroid eye disease (TED), current treatment pathways, and clinical assumptions informing a National Institute for Health and Care Excellence (NICE) health technology assessment (HTA).
METHODS: Qualitative interviews were conducted with three key opinion leaders (KOLs) experienced in TED management within National Health Services (NHS) clinical practice in England. Discussions explored post-treatment flare rates, comparator relevance, subgroup severity, treatment positioning, long-term disease assumptions, quality-of-life (QOL) burden, healthcare resource utilisation, and the generalisability of clinical trial populations to NHS practice.
RESULTS: Clinical experts reported that upon disease onset, TED impacts patients’ QOL continuously throughout their life. They considered a ≥2 mm reduction in proptosis clinically meaningful and associated with reduced morbidity, lower surgical burden, and less complex decompression procedures. KOLs agreed that intravenous methylprednisolone (IVMP) ± mycophenolate mofetil (MMF) primarily improves inflammatory activity rather than proptosis or diplopia. Experts considered higher flare rates with IVMP ± MMF versus teprotumumab clinically plausible and supported assumptions of lower surgical burden following teprotumumab compared with IVMP ± MMF. A subgroup with proptosis ≥3 mm and diplopia was considered representative of severe disease in NHS practice and associated with substantial functional and psychological burden. Teprotumumab’s trial populations were considered broadly generalisable to UK clinical practice. Experts supported the clinical rationale for teprotumumab use irrespective of prior steroid exposure.
CONCLUSIONS: UK TED specialists supported the clinical relevance of teprotumumab in active moderate-to-severe TED. Experts confirmed substantial unmet need, limitations of current steroid-based management, and the importance of teprotumumab’s effects on reducing proptosis and diplopia. Findings support the use of teprotumumab irrespective of prior steroid exposure and reinforce its potential to reduce long-term morbidity.