New integrated data and follow-up outcomes From Two Tepezza pivotal trials published in The Lancet Diabetes & Endocrinology.- Horizon Therapeutics

Horizon Therapeutics plc announced that new pooled data from the Tepezza (teprotumumab-trbw) Phase II and Phase III clinical trials are now published in The Lancet Diabetes & Endocrinology.. The data further reinforce that Tepezza significantly improves proptosis (eye bulging) and diplopia (double vision) for TED patients in different subgroups, with most maintaining a long-term response. In this report, treatment study outcomes and follow-up off-treatment data were integrated from two 24-week multicenter, double-masked, placebo-controlled clinical trials where patients were randomized to receive Tepezza (n=84) or placebo (n=87) once every three weeks for a total of eight infusions. The final treatment study visit was at Week 24, which was three weeks after the final infusion. Responses were also evaluated at seven weeks and 51 weeks after the final dose of Tepezza. Responses were analyzed for proptosis and diplopia, as well as a post-hoc analysis of a combined outcome measure: the “ophthalmic composite outcome.” The composite outcome is calculated as the percentage of patients with clinical improvement in one eye in at least two of the following: 1) proptosis, 2) diplopia, 3) eyelid swelling, 4) lid aperture, 5) globe motility, and 6) Clinical Activity Score, without deterioration of at least two of these outcomes in either eye. p> New Study Findings :i. There was no evidence for acute disease rebound (increase in percentage of patients no longer meeting proptosis, diplopia or ophthalmic composite outcome) seven weeks after the last dose of Tepezza. ii.Proptosis (87 percent; 62/71), diplopia (66 percent; 38/58) and ophthalmic composite outcome (92 percent; 66/72) responses were observed seven weeks after the last dose of Tepezza. iii. A post-hoc analysis of the composite ophthalmic outcome indicated that 81 percent (68/84) of Tepezza patients versus 44 percent (38/87) of placebo patients were responders at Week 24. iv. Proptosis (67 percent; 38/57), diplopia (69 percent; 33/48) and composite outcome response (83 percent; 48/58) were observed 51 weeks after the last dose of Tepzza for those who had long-term off-treatment data available. Efficacy in Difficult-to-Treat Patients at Week 24 : In a post-hoc analysis, Tepezza-treated patients with more severe disease (those with greater than 3 mm of proptosis and/or inconstant or constant diplopia) and those with less severe disease at baseline both experienced significant improvements in proptosis and diplopia. i. In patients with more severe disease, those treated with Tepezza had a proptosis response of 79 percent (50/63) compared to 17 percent (11/65) of those who received placebo (P<0.0001), and a diplopia response of 68 percent (38 56) compared to 31 percent of those who received placebo (15 49) (p><0.0001). ii. in patients with less severe disease, those treated with tepezza had a proptosis response of 71 percent (15 21) compared to 9 percent in those who received placebo (2 22) p><0.0001, and a diplopia response of 80 percent (8 10) compared to 30 percent in placebo (3 10) (p="0.015)." in post-hoc analyses, patients who received tepezza in both the lower baseline cas subgroup (4 or 5) and the higher cas subgroup (6 or 7) demonstrated statistically significant improvements compared with placebo in proptosis and diplopia. overall response and cas of 0 or 1 response also improved. post-hoc analysis from the phase iii study demonstrates that in patients treated with teprotumumab, those with higher ( greater than 10 iu l) or lower ( less then 10 iu l) serum thyrotropin-binding inhibitory immunoglobulin (tbii) baseline levels both had a proptosis response (mean reduction of -3.65 mm and -3.01 mm, respectively) with no treatment difference between the two groups (p="0.43)." in patients with higher baseline tbii, 71 percent (10 14) of patients who received tepezza experienced an improvement in diplopia compared to 23 percent (3 13) of patients who received placebo (p="0.0046)." adherence and safety : i. nearly 91 percent of patients in the tepezza treatment group (76 84) and the placebo treatment group (79 87) completed the randomized, double-masked treatment period. ii. there were no new safety concerns identified in the follow-up period or as part of the pooled analysis that had not been identified in the 24-week treatment period. of those patients who experienced adverse events, most were mild to moderate (grade 1 or 2) in intensity during the follow-up period. there were no serious adverse events related to tepezza treatment during the follow-up period, as assessed by trial investigators. iii.no anti-drug antibodies were reported that impacted safety or efficacy. iv. of the most commonly reported adverse events with tepezza, muscle spasm (18 percent, 95 percent ci 7.3–28.7), hearing loss (10 percent) and hyperglycemia (8 percent, 95 percent ci 1.7–15.0) had the greatest risk difference from placebo. hearing impairment events were all classified as non-serious and all patients continued in the study without event worsening or discontinuing treatment. see- 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 .prof george j kahaly, md, prof raymond s douglas, md , robert j holt, pharmd, at al.,published:april 15, 2021doi:https: doi.org 10.1016 s2213-8587(21)00056-5.>