Recent advances in the medical management of thyroid eye disease

Purpose of review Thyroid eye disease (TED) is a debilitating autoimmune disorder that can cause facial disfigurement, impair vision and reduce the quality of life. Novel insights into the pathogenesis of TED in the recent years have stimulated efforts to develop newer targeted medical therapies. This review summarizes latest advances in the medical management of TED, with a particular focus on novel targeted therapies. Recent findings Intravenous methylprednisolone is the conventional first line treatment for active moderate-to-severe TED. Although it is effective in reducing soft tissue inflammation associated with TED, it has limited efficacy in resolving proptosis and diplopia. Teprotumumab, a monoclonal antibody against insulin-like growth factor-1 receptor (IGF-1R), has emerged as an important disease modifying drug for TED. It is highly effective in reducing activity and improving manifestations of TED, including proptosis and diplopia. However, concerns remain related to its limited availability, high cost, potential adverse effects such as hearing loss, and durability of its treatment effects. More recently, Veligrotug (a full antagonist monoclonal antibody to IGF-1R) hasalso been shown to be effective in the treatment of active moderate-to-severe TED. Furthermore, there is some evidence to support the use of rituximab (monoclonal antibody against CD20) and tocilizumab (monoclonal antibody against interleukin-6) in early-onset and steroid-resistant active TED, respectively. Multiple other new forms of targeted therapies are currently being studied. Summary The development of novel targeted medications with expanding therapeutic options may facilitate personalized management of TED in the future.