The mechanism of action of teprotumumab in patients with TED has not been fully characterized. Teprotumumab-trbw binds to IGF-1R and blocks its activation and signaling.

IGF-1R, insulin-like growth factor-1 receptor.

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TEPEZZA is a prescription medication
administered via IV infusion
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A full course of treatment with TEPEZZA is 8 IV infusions, given in the arm once every 3 weeks.1 TEPEZZA may be administered at an infusion center, your practice, a hospital, or your patient’s home.

Care coordination is essential to reduce
the burden of TED

3 steps for TEPEZZA care coordination:

DEVELOP communication channel for patient’s TED team

  • Endocrinologist screens all Graves' patients for TED, asks patient about TED symptoms, and refers patient to TED Specialist for evaluation
  • Eye care provider conducts comprehensive TED eye exam and baseline assessment including QOL and CAS and refers patient to endocrinologist for thyroid management
  • TED Specialist confirms TED diagnosis

ESTABLISH roles and responsibilities for documentation and monitoring

  • Endocrinologist monitors thyroid levels and manages certain adverse events (eg, hyperglycemia) during treatment
  • TED Specialist prescribes treatment, submits clinical documentation, monitors treatment results, and manages AEs during treatment

DISCUSS patient progress and results of treatment

  • Endocrinologist continues monitoring thyroid levels
  • Endocrinologist, eye care provider, and TED Specialist confer on treatment results and quality of life impact
  • TED Specialist coordinates post-treatment follow-up and care

AE, adverse event; IV, intravenous; QOL, quality of life.

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While listed as a recommended care coordination team, it is the decision of your team on how you coordinate care with your patient throughout the course of treatment.

Before beginning TEPEZZA, be aware that insurance payors may require the Clinical Activity Score (CAS),*† thyroid labs, and/or documentation of previously tried medications (such as steroids) for treatment approval. It is recommended that you download the Clinical Documentation Tearpad to appropriately document inflammatory signs and symptoms of TED, such as CAS. It is important to ask patients if they have, or have ever had, any of these CAS symptoms.2-4 It may even be helpful to ask your patient to share a photo of how he or she used to look.

Things to remember before starting your patients on TEPEZZA:

  • TEPEZZA is a specialty medicine and will require prior authorization by insurance
  • TEPEZZA is an intravenous medicine given in the arm, and a full course of treatment is 8 IV infusions1
  • In clinical studies, while many patients experienced a reduction in proptosis, redness, pain, and swelling as early as 6 weeks after start of treatment with TEPEZZA, it is recommended that patients receive the full course of treatment, as improvement continues across all 8 IV infusions1,5,6

*CAS is a 7-point composite score measuring spontaneous orbital pain, gaze-evoked orbital pain, eyelid swelling, eyelid erythema, conjunctival redness, chemosis, and inflammation of caruncle or plica. A lower score indicates fewer symptoms.4

†The CAS is a composite score with equal weighting of a number of factors. However, the factors may not be of equal clinical weight to patients or to physicians treating these patients.

It is important to set expectations and educate patients
about their treatment journey

treatment-journeytreatment-journey

  • Once treatment is started, be sure to ask your patients about their results with TEPEZZA as well as any possible adverse reactions after every infusion

Download the TEPEZZA Access Roadmap, or speak with your Horizon Representative for more
detailed information on the steps to get your patients started on TEPEZZA.

HORIZON BY YOUR SIDE icon

Support for patients on TEPEZZA

Horizon believes cost should never stop someone from getting the medicine they need. Support for your patients is available from Horizon By Your Side.

TEPEZZA may improve the signs and symptoms of TED, including
physical appearance and functional vision1,6-8‡

TEPEZZA patients often talk about how TEPEZZA worked for them.

During treatment with TEPEZZA, my eye bulging became less and less. My double vision went away. The redness was gone. And the pain and swelling under my eyes improved.

Jeanne T., real TEPEZZA patient9

‡Appearance and functional vision were patient-reported based on GO-QOL scale.

Find a TED SpecialistFind a TED Specialist

How to discuss TEPEZZA with your patients

Find a TED SpecialistFind a TED Specialist

Find a TED Specialist

INDICATION

TEPEZZA is indicated for the treatment of Thyroid Eye Disease regardless of Thyroid Eye Disease activity or duration.

IMPORTANT SAFETY INFORMATION

WARNINGS AND PRECAUTIONS

Infusion Reactions: TEPEZZA may cause infusion reactions. Infusion reactions have been reported in approximately 4% of patients treated with TEPEZZA. Reported infusion reactions have usually been mild or moderate in severity. Signs and symptoms may include transient increases in blood pressure, feeling hot, tachycardia, dyspnea, headache, and muscular pain. Infusion reactions may occur during an infusion or within 1.5 hours after an infusion. In patients who experience an infusion reaction, consideration should be given to premedicating with an antihistamine, antipyretic, or corticosteroid and/or administering all subsequent infusions at a slower infusion rate.

Preexisting Inflammatory Bowel Disease: TEPEZZA may cause an exacerbation of preexisting inflammatory bowel disease (IBD). Monitor patients with IBD for flare of disease. If IBD exacerbation is suspected, consider discontinuation of TEPEZZA.

Hyperglycemia: Increased blood glucose or hyperglycemia may occur in patients treated with TEPEZZA. In clinical trials, 10% of patients (two-thirds of whom had preexisting diabetes or impaired glucose tolerance) experienced hyperglycemia. Hyperglycemic events should be controlled with medications for glycemic control, if necessary. Assess patients for elevated blood glucose and symptoms of hyperglycemia prior to infusion and continue to monitor while on treatment with TEPEZZA. Ensure patients with hyperglycemia or preexisting diabetes are under appropriate glycemic control before and while receiving TEPEZZA.

Hearing Impairment Including Hearing Loss: TEPEZZA may cause severe hearing impairment including hearing loss, which in some cases may be permanent. Assess patients’ hearing before, during, and after treatment with TEPEZZA and consider the benefit-risk of treatment with patients.

ADVERSE REACTIONS

The most common adverse reactions (incidence ≥5% and greater than placebo) are muscle spasm, nausea, alopecia, diarrhea, fatigue, hyperglycemia, hearing impairment, dysgeusia, headache, dry skin, weight decreased, nail disorders, and menstrual disorders.

Please see Full Prescribing Information for more information.

INDICATION

TEPEZZA is indicated for the treatment of Thyroid Eye Disease regardless of Thyroid Eye Disease activity or duration.

IMPORTANT SAFETY INFORMATION

WARNINGS AND PRECAUTIONS

Infusion Reactions: TEPEZZA may cause infusion reactions. Infusion reactions have been reported in approximately 4% of patients treated with TEPEZZA. Reported infusion reactions have usually been mild or moderate in severity. Signs and symptoms may include transient increases in blood pressure, feeling hot, tachycardia, dyspnea, headache, and muscular pain. Infusion reactions may occur during an infusion or within 1.5 hours after an infusion. In patients who experience an infusion reaction, consideration should be given to premedicating with an antihistamine, antipyretic, or corticosteroid and/or administering all subsequent infusions at a slower infusion rate.

Preexisting Inflammatory Bowel Disease: TEPEZZA may cause an exacerbation of preexisting inflammatory bowel disease (IBD). Monitor patients with IBD for flare of disease. If IBD exacerbation is suspected, consider discontinuation of TEPEZZA.

Hyperglycemia: Increased blood glucose or hyperglycemia may occur in patients treated with TEPEZZA. In clinical trials, 10% of patients (two-thirds of whom had preexisting diabetes or impaired glucose tolerance) experienced hyperglycemia. Hyperglycemic events should be controlled with medications for glycemic control, if necessary. Assess patients for elevated blood glucose and symptoms of hyperglycemia prior to infusion and continue to monitor while on treatment with TEPEZZA. Ensure patients with hyperglycemia or preexisting diabetes are under appropriate glycemic control before and while receiving TEPEZZA.

Hearing Impairment Including Hearing Loss: TEPEZZA may cause severe hearing impairment including hearing loss, which in some cases may be permanent. Assess patients’ hearing before, during, and after treatment with TEPEZZA and consider the benefit-risk of treatment with patients.

ADVERSE REACTIONS

The most common adverse reactions (incidence ≥5% and greater than placebo) are muscle spasm, nausea, alopecia, diarrhea, fatigue, hyperglycemia, hearing impairment, dysgeusia, headache, dry skin, weight decreased, nail disorders, and menstrual disorders.

Please see Full Prescribing Information for more information.

  1. TEPEZZA (teprotumumab-trbw) [prescribing information] Horizon. 
  2. Smith TJ, Kahaly GJ, Ezra DG, et al. Teprotumumab for thyroid-associated ophthalmopathy. N Engl J Med. 2017;376(18)(suppl):1748-1761. https://www.nejm.org/doi/suppl/10.1056/NEJMoa1614949/suppl_file/nejmoa1614949_appendix.pdf
  3. Smith TJ, Kahaly GJ, Ezra DG, et al. Teprotumumab for thyroid-associated ophthalmopathy. N Engl J Med. 2017;376(18)(protocol):1748-1761. https://www.nejm.org/doi/suppl/10.1056/NEJMoa1614949/suppl_file/nejmoa1614949_protocol.pdf
  4. Wiersinga WM, Perros P, Kahaly GJ, et al. Clinical assessment of patients with Graves’ orbitopathy: the European Group on Graves’ Orbitopathy recommendations to generalists, specialists and clinical researchers. Eur J Endocrinol. 2006;155(3):387-389.
  5. Smith TJ, Kahaly GJ, Ezra DG, et al. Teprotumumab for thyroid-associated ophthalmopathy. N Engl J Med. 2017;376(18):1748-1761. 
  6. Douglas RS, Kahaly GJ, Patel A, et al. Teprotumumab for the treatment of active Thyroid Eye Disease. N Engl J Med. 2020;382(4):341-352. 
  7. Smith TJ, Hoa N. Immunoglobulins from patients with Graves’ disease induce hyaluronan synthesis in their orbital fibroblasts through the self-antigen, insulin-like growth factor-I receptor. J Clin Endocrinol Metab. 2004;89:5076-5080. 
  8. Kahaly GJ, Douglas RS, Holt RJ, Sile S, Smith TJ. Teprotumumab for patients with active Thyroid Eye Disease: a pooled data analysis, subgroup analyses, and off-treatment follow-up results from two randomised, double-masked, placebo-controlled, multicentre trials. Lancet. 2021;9(6):360-372. 
  9. Data on File. Horizon, May 2022.