Teprotumumab in thyroid eye disease: Evidence, challenges, and the Indian perspective

ABSTRACT

Thyroid eye disease (TED) represents a significant clinical burden in patients with Graves’ disease, with limited treatment options beyond glucocorticoids and conventional immunosuppression. Teprotumumab, a human monoclonal antibody targeting the insulin-like growth factor-1 receptor, has emerged as the first disease-modifying therapy specifically approved for active, moderate-to-severe TED. This narrative mini-review synthesizes current evidence on existing pharmacological management of TED, critically examines the gaps in conventional therapy and evaluates the mechanism of action, clinical efficacy, and safety profile of teprotumumab. Special emphasis is placed on cost considerations, accessibility challenges, and the positioning of this therapy within the Indian healthcare context, where resource constraints and out-of-pocket expenditure realities necessitate careful appraisal of high-cost biologics. While teprotumumab demonstrates remarkable efficacy in reducing proptosis and improving the quality of life, its prohibitive cost, limited availability in India, and safety concerns regarding hyperglycemia and hearing dysfunction require balanced consideration. This review provides Indian endocrinologists with an evidence-based framework for understanding teprotumumab’s role and limitations in contemporary TED management.