Table 7.
Logistics of Medical Therapy for Thyroid Eye Disease
| Drug | Route | Frequency and duration | Total drug cost/full treatment (Euros and U.S. dollars) |
Ratio of cost of full treatment with drug over cost of full treatment with IVGCa |
Impact of drug on vaccinationsb | ||
|---|---|---|---|---|---|---|---|
| € | $ | € | $ | ||||
| IVGC | IV | 0.5 g weekly for 6 weeks, followed by 0.25 g weekly for 6 weeks | €70.0 | $172 | 1 | 1 | Decreased efficacy of vaccine; live vaccines deferred for 1 month after drug discontinuation |
| OGC | PO | Daily for 3 months (starting with 100 mg prednisolone daily, then tapering dose, cumulative dose 4 g) | €73.6 | $440 | 1 | 3 | Decreased efficacy of vaccine; live vaccines deferred for 1 month after drug discontinuation |
| MMF | PO | 0.72 g daily for 24 weeks | €411 | $1,191 | 6 | 7 | Possible decreased efficacy of vaccine but data are controversial |
| RTX | IV | 1 g two doses 1 weekly for 2 weeks | €4,308 | $19,636 | 62 | 114 | Decreased efficacy of vaccine; defer vaccination post-therapy until after B cells recovery |
| 0.5 g single dose | €1,698 | $4,914 | 24 | 29 | |||
| 0.1 g single dose | €338 | $990 | 5 | 6 | |||
| TEP | IV | Every 3 weeks for 6 months (first dose 10 mg/kg, subsequent doses 20 mg/kg, total number of infusions eight) | Not licensed in Europe | $357,997 for a 75 kg patient | 5110 | 2080 | Unknown |
| TCZ | IV | 8 mg/kg every 4 weeks for 12 weeks (four doses) | €4,266 | $14,519 | 61 | 84 | Decreased efficacy of vaccine |
a
Note on relative pricing—A course of IVGC costs €70.0 in Europe and $172 in the United States, derived from (www.pharmacychecker.com). These costs reference the price of medication alone, excluding administration costs. Figures are EU average costs supplied by manufacturers (Roche global) and approved by EMA (personal communication with one of coauthors).
b
Best to complete vaccination series at least 1 month before initiation of all these agents. Data about the impact of various drugs on vaccines are mainly derived from the literature on their use in rheumatological disorders.
IV, intravenous; PO, oral dosing.