Hearing Dysfunction After Treatment With Teprotumumab for Thyroid Eye Disease

circle PURPOSE: To characterize the frequency, severity, and resolution of hearing dysfunction in patients treated with teprotumumab for thyroid eye disease (TED). circle DESIGN: Prospective observational case series. circle METHODS: Ophthalmic examination and adverse event assessment, including otologic symptoms, were performed at baseline, after infusions 2, 4, and 8, and at 6-month follow-up in consecutive patients who received at least 4 teprotumumab infusions. Laboratory test results were collected at baseline and during treatment. Audiometry, patulous eustachian tube (PET) testing, and otolaryn-gology evaluation were obtained for patients with new or worsening otologic symptoms, with a subset obtaining baseline and posttreatment testing. circle RESULTS: Twenty-seven patients were analyzed (24 females, 3 males, average 56.3 years old). Twentytwo patients (81.5%) developed new subjective oto-logic symptoms, after a mean of 3.8 infusions (SD 1.8). At 39.2-week average follow-up after the last infusion, most patients with tinnitus (100%), ear plugging/fullness (90.9%), and autophony (83.3%) experienced symptom resolution, whereas only 45.5% (5 of 11) of patients with subjective hearing loss/decreased word comprehen-sion experienced resolution. Six patients underwent base-line and posttreatment audiometry, 5 of whom devel-oped teprotumumab-related sensorineural hearing loss (SNHL) and 1 patient also developed PET. Three of the 5 patients with teprotumumab-related SNHL had persis-tent subjective hearing loss at last follow-up. A prior his-tory of hearing loss was discovered as a risk factor for teprotumumab-related SNHL (P =.008). circle CONCLUSIONS: Hearing loss is a concerning adverse event of teprotumumab, and its mechanism and re-versibility should be further studied. Until risk factors for hearing loss are better understood, we recommend base-line audiometry with PET testing and repeat testing if new otologic symptoms develop. Screening, monitoring, and prevention guidelines are needed.

Automated summary

This study aims to characterize the frequency, severity, and resolution of hearing dysfunction in patients treated with teprotumumab for TED. The study found that hearing loss is a concerning adverse event of teprotumumab, and further studies are needed to understand its mechanism and reversibility. Baseline audiometry and repeat testing are recommended for monitoring and prevention.