Efficacy of Anti-TNF-alpha agents in Active Thyroid Eye Disease
Farzad Pakdel1 *, Niloofar Pirmarzdashti2 , Annousheh Haghighi3
- Department of Oculo-Facial Plastic Surgery, Farabi Hospital, Eye Research Center Tehran University of Medical Sciences, Tehran, Iran.
- Eye Research Center Tehran University of Medical Sciences, Tehran, Iran.
- Department of Rheumatology, Iran University of Medical Sciences, Tehran, Iran.
Abstract: This study was presented as oral lecture in ASOPRS meeting 2022. The key role of tissue necrosis factor alpha has been shown in the pathophysiology of thyroid eye disease. In addition, few reports showed that anti-TNF-alpha agents could decrease orbital inflammation in idiopathic orbital inflammatory disease. However, no reliable consistent effect was found. In this study we aimed to report the effect of anti-TNF alpha agents in treatment of patients with active thyroid eye disease (TED) who could not either take or showed resistance to corticosteroids.
Methods: Data of all patients with active TED from January 2014 to December 2018, that received anti-TNF alpha agents because they could not either take or showed resistance to corticosteroids were reviewed. Data included clinical and imaging findings and clinical activity score (CAS). Those with follow-up less than 9 months were excluded.
Results: Data of eight eligible patients were analyzed. Mean age was 54.6 (SD= 7.08, range=42-65) years. Five were male. The reason for abandonment from corticosteroid included: gastrointestinal bleeding (n=1), congestive heart failure (n=1), diabetic hyperosmolar state (n=1), non- or inadequate response to corticosteroid regimen (n=5). Patients received one anti-TNF alpha agent as single main treatment including infliximab (n=3), etanercept (n=3), Adalimumab (n=2). CAS score decreased from baseline 5.5 (SD= 1.69) to 0.5 (SD= 0.75) (p=0.0001). Proptosis value showed decreased from baseline 24.12 mm (SD= 2.23) to 22.12 (SD=1.88) after treatment (p=0.037). Two showed recurrence of orbital inflammation one with infliximab and another with etanercept. Both were controlled by re-starting the same agent. Notably the two patients that received adalimumab showed resolution of diplopia and decrease in proptosis in contrast to none of the other six patients. Mean follow up time was 27.75 (range: 15-46, SD= 10.30) months. Four (50%) patients were current smokers. Five patients had DON before anti-TNF alpha. Four of them were smokers. Three of them improved by anti-TNF alpha medication only.
Conclusion: This study supports the efficacy of anti-TNF alpha agents in active TED. Further they may be considered in patients that cannot take corticosteroids or are resistant to steroid therapy. Results of this study justify future comparative studies to verify efficacy of this modality of treatment in patients with active TED.
