Thyroid eye disease drug linked to hearing problems

Patients treated with teprotumumab for thyroid eye disease frequently develop otologic symptoms, and those who already have hearing problems prior to treatment are at heightened risk of progressing to sensorineural hearing loss, a study reports.

The study included 27 consecutive patients (average age 56.3 years, 24 women) who received at least four teprotumumab infusions. Researchers performed ophthalmic examination and adverse event assessment, including otologic symptoms, at baseline, after infusions 2, 4, and 8, and at 6-month follow-up. Data were collected at baseline and during treatment.

Patients with new or worsening otologic symptoms underwent audiometry, patulous Eustachian tube (PET) testing, and otolaryngology evaluation.

A total of 22 patients (81.5 percent) developed new subjective otologic symptom after a mean of 3.8 teprotumumab infusions. Over 39.2 weeks of follow-up after the last infusion, resolution of symptom occurred for most patients who experienced tinnitus (100 percent), ear plugging/fullness (90.9 percent), and autophony (83.3 percent). On the other hand, only 45.5 percent patients with subjective hearing loss/decreased word comprehension experienced resolution.

Of the six patients who underwent baseline and post-treatment audiometry, five developed teprotumumab-related sensorineural hearing loss (SNHL) and one patient also developed PET. Three patients with teprotumumab-related SNHL had persistent subjective hearing loss at the last follow-up.

Further analysis revealed a prior history of hearing loss to be a risk factor for teprotumumab-related SNHL (p=0.008).

The present data highlight the importance of performing audiometry with PET testing at baseline and repeat testing if new otologic symptoms develop among patients receiving teprotumumab treatment. Screening, monitoring, and prevention guidelines are warranted.