Treatment for Acute Thyroid Eye Disease using Anti-VEGF Therapy

Anti-VEGF Therapy for Acute Thyroid Eye Disease (AcTED Study)

This study tests if a new injection treatment can help people with acute Thyroid Eye Disease feel better and manage their symptoms.

Quick facts

• Phase: Phase 2
• Study type: Interventional
• Enrollment: 24 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Massachusetts Eye and Ear Infirmary (Academic / other)
• Drugs / interventions: teprotumumab, radiation
• Locations: 1 site (Boston, Massachusetts)
• Trial ID: NCT04311606 on ClinicalTrials.gov

What this trial studies

This clinical trial evaluates the safety and tolerability of sub-tenon injections of aflibercept, either combined with saline or hyaluronidase, in patients suffering from acute Thyroid Eye Disease (TED). Participants will receive three injections and will be monitored for adverse events over a 45-day period. The study aims to determine the effectiveness of this treatment approach in managing the symptoms of TED.

Who should consider this trial

Good fit: Ideal candidates for this study are adults aged 18 and older with active Thyroid Eye Disease and a Clinical Activity Score between 3 and 5.

Not a fit: Patients with a history of orbital surgery, optic neuropathy, or those currently on systemic or topical steroids may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could provide a new therapeutic option for patients with acute Thyroid Eye Disease, potentially improving their symptoms and quality of life.

How similar studies have performed: Other studies have explored anti-VEGF therapies in similar contexts, showing promising results, but this specific approach is relatively novel.

Eligibility criteria

Inclusion Criteria:

1. Minimum of 18 years-old
2. Active Thyroid Eye Disease
3. Clinical Activity Score (CAS) between 3 and 5, inclusive
4. Phakic and pseudophakic eyes are allowed in the study.
5. Willing and able to provide written informed consent after the nature of the study has been explained, and prior to any research-related procedures
6. Willing and able to comply with clinic visits and study-related procedures
7. Only one eye will be enrolled. The worse eye (demonstrating any of these features:

worse HVF results, worse restricted motility, worse visual acuity, worse edema, worse proptosis, worse eyelid retraction) will be enrolled. If both eyes are equivalent, we will enroll the non-dominant eye.

Exclusion Criteria:

1. History of orbital, strabismus, or eyelid surgery or orbital radiation
2. Optic neuropathy or other vision-threatening signs
3. Patients currently on systemic or topical steroids. If they received steroids in the past, they would require a 6 week washout period and the cumulative dose of steroids must be less than 1 gram of methylprednisolone (or equivalent). During the washout period we will contact patients by phone weekly to monitor their safety and address any concerns they may have related to no longer taking steroids .
4. Patients who have taken teprotumumab (Tepezza.)
5. Patients who have received intraocular anti-VEGF medications within 1 year of screening
6. Patients who have a history of receiving systemic anti-VEGF
7. Presence of other retinal vascular diseases (diabetic retinopathy, vein occlusion) that could affect the VEGF levels within the eye
8. History of stroke or prior myocardial infarction
9. Known hypersensitivity to aflibercept
10. Infectious conjunctivitis, keratitis, or endophthalmitis of either eye
11. Presence of a glaucoma shunting or filtration device that is subconjunctival
12. Previous participation in any studies of investigational drugs within 1 month preceding Day 0
13. Any clinically significant acute or chronic medical condition that would preclude participation in a clinical study
14. Pregnant or breast-feeding women
15. Sexually active men\* or women of childbearing potential\*\* who are unwilling to practice adequate contraception during the study (adequate contraceptive measures include stable use of oral contraceptives or other prescription pharmaceutical contraceptives for 2 or more menstrual cycles prior to screening; intrauterine device \[IUD\]; bilateral tubal ligation; vasectomy; condom plus contraceptive sponge, foam, or jelly, or diaphragm plus contraceptive sponge, foam, or jelly)
16. History of hyaluronidase (HA) injection after the diagnosis of thyroid eye disease
17. Taking part in other research studies in the past 12 months that have involved radiation exposure
18. Participated in other research studies in the past 12 months that required radiologic imaging (particularly CT scans and not MRIs)

Where this trial is running

Boston, Massachusetts

• Mass Eye and Ear — Boston, Massachusetts, United States (Recruiting)

Study contacts

• Principal investigator: Nahoung Grace Lee, MD — Investigator
• Study coordinator: Nahoung Grace Lee, MD

Conditions Thyroid Eye Disease; VEGF