[PMID]: | 28467880 |
[Au] Autor: | Smith TJ; Kahaly GJ; Ezra DG; Fleming JC; Dailey RA; Tang RA; Harris GJ; Antonelli A; Salvi M; Goldberg RA; Gigantelli JW; Couch SM; Shriver EM; Hayek BR; Hink EM; Woodward RM; Gabriel K; Magni G; Douglas RS |
[Ad] Dirección: | From the Department of Ophthalmology and Visual Sciences, Kellogg Eye Center (T.J.S., R.S.D.), and the Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine (T.J.S.), University of Michigan Medical School, Ann Arbor; the Department of Medicine, Johannes Gutenberg Unive |
[Ti] Título: | Teprotumumab for Thyroid-Associated Ophthalmopathy. |
[So] Fuente: | N Engl J Med;376(18):1748-1761, 2017 05 04. |
[Is] ISSN: | 1533-4406 |
[Cp] País de publicación: | United States |
[La] Idioma: | eng |
[Ab] Resumen: | BACKGROUND: Thyroid-associated ophthalmopathy, a condition commonly associated with Graves' disease, remains inadequately treated. Current medical therapies, which primarily consist of glucocorticoids, have limited efficacy and present safety concerns. Inhibition of the insulin-like growth factor I receptor (IGF-IR) is a new therapeutic strategy to attenuate the underlying autoimmune pathogenesis of ophthalmopathy. METHODS: We conducted a multicenter, double-masked, randomized, placebo-controlled trial to determine the efficacy and safety of teprotumumab, a human monoclonal antibody inhibitor of IGF-IR, in patients with active, moderate-to-severe ophthalmopathy. A total of 88 patients were randomly assigned to receive placebo or active drug administered intravenously once every 3 weeks for a total of eight infusions. The primary end point was the response in the study eye. This response was defined as a reduction of 2 points or more in the Clinical Activity Score (scores range from 0 to 7, with a score of ≥3 indicating active thyroid-associated ophthalmopathy) and a reduction of 2 mm or more in proptosis at week 24. Secondary end points, measured as continuous variables, included proptosis, the Clinical Activity Score, and results on the Graves' ophthalmopathy-specific quality-of-life questionnaire. Adverse events were assessed. RESULTS: In the intention-to-treat population, 29 of 42 patients who received teprotumumab (69%), as compared with 9 of 45 patients who received placebo (20%), had a response at week 24 (P<0.001). Therapeutic effects were rapid; at week 6, a total of 18 of 42 patients in the teprotumumab group (43%) and 2 of 45 patients in the placebo group (4%) had a response (P<0.001). Differences between the groups increased at subsequent time points. The only drug-related adverse event was hyperglycemia in patients with diabetes; this event was controlled by adjusting medication for diabetes. CONCLUSIONS: In patients with active ophthalmopathy, teprotumumab was more effective than placebo in reducing proptosis and the Clinical Activity Score. (Funded by River Vision Development and others; ClinicalTrials.gov number, NCT01868997 .). |
[Mh] Términos MeSH primario: |
Anticuerpos Monoclonales/uso terapéutico Oftalmopatía de Graves/tratamiento farmacológico Factores Inmunológicos/uso terapéutico Factor I del Crecimiento Similar a la Insulina/antagonistas & inhibidores
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[Mh] Términos MeSH secundario: |
Adulto Anciano Anticuerpos Monoclonales/efectos adversos Complicaciones de la Diabetes Método Doble Ciego Exoftalmia/tratamiento farmacológico Femenino Oftalmopatía de Graves/complicaciones Seres Humanos Hiperglucemia/inducido químicamente Factores Inmunológicos/efectos adversos Análisis de Intención de Tratar Modelos Logísticos Masculino Mediana Edad Calidad de Vida
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[Pt] Tipo de publicación: | JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL |
[Nm] Nombre de substancia:
| 0 (Antibodies, Monoclonal); 0 (Immunologic Factors); 0 (R-1507 monoclonal antibody); 67763-96-6 (Insulin-Like Growth Factor I) |
[Em] Mes de ingreso: | 1705 |
[Cu] Fecha actualización por clase: | 171208 |
[Lr] Fecha última revisión: | 171208 |
[Sb] Subgrupo de revista: | AIM; IM |
[Da] Fecha de ingreso para procesamiento: | 170504 |
[Cl] Clinical Trial: | ClinicalTrial
|
[St] Status: | MEDLINE |
[do] DOI: | 10.1056/NEJMoa1614949 |