Teprotumumab Improves Quality of Life in Thyroid Eye Disease: Meta-analysis and Matching-adjusted Indirect Comparison

Context Teprotumumab and/or intravenous methylprednisolone (IVMP) are first-line treatments for thyroid eye disease (TED)/Graves’ orbitopathy. Direct comparisons of these treatments on Graves’ Orbitopathy Quality of Life Questionnaire (GO-QoL) are lacking. Objective Systematic review, meta-analysis, and matching-adjusted indirect treatment comparison (MAIC) of GO-QoL improvements. Methods A literature search was performed using PubMed and Embase between inception to April 1, 2023, including studies of patients with moderate to severe active TED treated with teprotumumab or IVMP. Changes in GO-QoL scores and appearance and visual function subscales were extracted. Two teprotumumab (n = 84) and placebo (n = 87) randomized clinical trials and 5 studies with IVMP (4.5 mg/12 weeks, n = 304) were identified. MAIC compared teprotumumab/placebo by adjusting for baseline GO-QoL, diplopia, proptosis, smoking, age, and sex. Significant improvements in overall GO-QoL were observed for teprotumumab vs IVMP [mean difference (MD): 13.26; 95% confidence interval (CI): 7.44, 19.09) and placebo (MD: 12.57; 95% CI: 5.94, 19.21), but not IVMP vs placebo (MD: −2.06; 95% CI: −8.24, 4.12). Improvements were noted in appearance subscale GO-QoL for teprotumumab vs IVMP (MD: 7.50; 95% CI: 0.35, 14.64) and placebo (MD: 10.80; 95% CI: 3.62, 17.98) but not for IVMP vs placebo (MD: 0.91; 95% CI: −6.36, 8.18). Visual subscale GO-QoL displayed greater improvements for teprotumumab vs IVMP (MD: 17.66; 95% CI: 7.86, 27.47) and placebo (MD: 14.54; 95% CI: 6.10, 22.99), with no significant change for IVMP vs placebo (MD: −3.65; 95% CI: −12.88, 5.57). Orbital pain, teprotumumab treatment, diplopia, proptosis, and male sex were significant independent predictors of overall GO-QoL (P < .05). Conclusion This unique analysis demonstrated a more clinically meaningful improvement in the health-related quality of life, as measured by the GO-QoL, for TED patients with teprotumumab vs both the most recommended IVMP dosage and placebo.