Table 2.
Recent literature summary of dysthyroid optic neuropathy treatments
| Author | Year | Design | Intervention | Patient type | Sample size | Follow-up (weeks) | Results |
|---|---|---|---|---|---|---|---|
|
| |||||||
| Précausta | 2017 | Case series | RTX (1000 mg IV × 2 doses every 2 weeks) | DON | 6 | 79.3 | Significant improvement in CAS, BCVA, and VF, but decompression was needed |
| Pascual-Camps | 2018 | Case report | TCZ (8 mg/kg IV × N doses every 4 weeks) | DON | 1 | 52 | Improved VF and BCVA after 2 infusions that remained stable at 1-year follow-up |
| Gold | 2018 | Retrospective study | ORT (20 Gy × 10 doses over 2 weeks) + prednisone (1 mg/kg × 14 doses everyday) or orbital decompression | DON | 104 | 162.4 | Most (93%) ORT patients responsive to steroids did not require decompression in the acute phase of disease and only 36.7% of ORT patients had elective surgery |
| Insull | 2019 | Case series | RTX (100 mg IV × 1 doses) + as needed IVMP (mean cumulative dose 2.3 g) | TED and DON | 12 | 25.2 | Significant improvement in CAS and VISA score with one patient requiring decompression for DON 2 mo after RTX treatment |
| Ito | 2019 | Retrospective study | IVMP (10 mg/kg × 3 doses everyday × 2–3 cycles) + ORT (20 Gy × 10 doses over 2 weeks) | TED and DON | 77 | 25 | DON, high TSAb, and lower standard deviation of T2 signal intensity were significant risk factors for disease recurrence after concurrent ORT and steroid therapy |
| Nicosia | 2019 | Retrospective study | IVMP (500 mg × 2 doses every week) + ORT (20 Gy × 10 doses over 2 weeks) | TED and DON | 40 | 56 | Improved BCVA in 27.5% and 21% of patients required decompression for recurrent disease at last follow-up |
| Yong | 2019 | Retrospective study | IVMP (500–1000 mgx3 doses everyday × 1–5 cycles)±MTX (12.5–15 mg POx24 doses every week) | DON | 72 | 72 | Significantly better BCVA and VISA at 3 months in patients on IVMP + MTX |
| Sanchez-Bilbao | 2020 | Retrospective study | TCZ (8 mg/kg IV every 4 weeks or 162 mg s.c. every week) | TED and DON | 48 | 64.4 | Significantly improved BCVA and CAS |
| Kaplan | 2020 | Case report | TCZ (8 mg/kg IV × 11 doses every 4 weeks) | DON | 1 | CAS improvement in TED refractory to IVMP and decompression | |
| Maldiney | 2020 | Case series | TCZ (8 mg/kg IV × 6–8 doses every 4 weeks) | DON | 3 | Improvement in BCVA and reduced EOM swelling on MRI | |
| Zhang | 2020 | Case series | RTX (500 mg IV xl dose) | DON | 2 | 104 | Developed DON at 2-month follow-up; both needed surgery |
| Choi | 2020 | Retrospective study | ORT (24 Gy in 12 fractions) | TED and DON | 62 | 24 | Resolution of DON in 76.9% of ORT treated patients |
| Garip-Kuebler | 2020 | Retrospective study | IVMP (500 mg × 8 doses every 3–4 days, 250 mg × 4 doses every 3–4 days) | DON | 25 | Better initial BCVA (0.3 logMAR) was predictive of better response to IVMP | |
| Sears | 2020 | Case series | Teprotumumab (10 mg/kg IV × 1 dose, 20 mg/kg × 7 doses every 3 weeks) | DON | 10 | 15 | Improvement in BCVA, APD, or both after two infusions in 70% of patients |
| Slentz | 2021 | Case report | Teprotumumab (10 mg/kg IV × 1 dose, 20 mg/kg × 7 doses every 3 weeks) | DON | 1 | 25 | Improvement of CAS, VF, and extraocular muscle size |
| Chiou | 2021 | Case series | Teprotumumab (10 mg/kg IV × 1 dose, 20 mg/kg × 7 doses every 3 weeks) | DON | 2 | 6 | Improvement in VF in mild DON previously treated with IVMP |
| Diniz | 2021 | Case series | Teprotumumab (10 mg/kg IV × 1 dose, 20 mg/kg × 7 doses every 3 weeks) | TED and DON | 21 | 30 | Improved BCVA, VF, and color vision |
| Lopez | 2021 | Case report | Teprotumumab (10 mg/kg IV × 1 dose, 20 mg/kg × 7 doses every 3 weeks) + oral prednisone (80 mg daily) | DON | 1 | 6 | Improved BCVA, APD color, and VF in TED previously treated with oral steroids |
| Hwang | 2021 | Case report | Teprotumumab (10 mg/kg IV × 1 dose, 20 mg/kg x7 doses every 3 weeks) | DON | 1 | 24 | Improved BCVA, APD VF, and color after two infusions in TED previously treated with steroids |
| Quah Qin | 2021 | Retrospective study | IVMP + MMF | TED and DON | 20 | 78 | Significant improvement in CAS, diplopia, and BCVA of 90% at 24 weeks that was stable to 78 weeks |
| Ozzello | 2021 | Case report | Teprotumumab (10 mg/kg IV × 1 dose, 20 mg/kg × 7 doses every 3 weeks) | DON | 1 | 6 | Improved proptosis and extraocular muscle swelling in chronic TED |
DON dysthyroid optic neuropathy, TED thyroid eye disease, RTX rituximab, TCZ tocilizumab, ORT orbital radiotherapy, MMF mycophenolate mofetil, IVMP intravenous methylprednisolone, MTX methotrexate, CAS clinical activity score, BCVA best corrected visual acuity, VF visual field, EOM extraocular muscle, TSAb thyroid stimulating antibody, VISA vision, inflammation, strabismus and appearance score, APD afferent pupillary defect