Efficacy and Safety of IGF-1 Receptor Inhibitors for Thyroid Eye Disease: Systematic Review and Meta-analysis of Randomized Controlled Trials.
Haiyang Zhang, Zixiang Zhang, Ting Lu et al.
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In 30 seconds
This systematic review and meta-analysis pooled randomized controlled trials comparing IGF-1 receptor inhibitors with placebo for thyroid eye disease (TED). Across 7 trials involving 669 patients, treatment improved several outcomes, including proptosis response (RR = 7.71, 95% CI 5.04-11.79, P < 0.001) and overall response (RR = 8.74, 95% CI 5.61-13.62, P < 0.001). Benefits were also reported for clinical activity, diplopia, proptosis change, and quality of life. Adverse events were more frequent with active treatment (RR = 1.15, 95% CI 1.06-1.24, P < 0.001); efficacy for proptosis reduction was greater in acute active TED.
Key findings
- IGF-1 receptor inhibitors improved proptosis response versus placebo (RR = 7.71, 95% CI 5.04-11.79, P < 0.001).
- Overall response was higher with inhibitors (RR = 8.74, 95% CI 5.61-13.62, P < 0.001).
- Treatment was associated with greater proptosis reduction (MD = - 2.22 mm, 95% CI - 2.45 to - 1.99 mm, P < 0.001) and quality-of-life improvement (MD = 10.48, 95% CI 6.95-14.00, P < 0.001).
- Pooled adverse-event rates were higher with active treatment (RR = 1.15, 95% CI 1.06-1.24, P < 0.001).
Why it matters
The pooled randomized evidence indicates that IGF-1 receptor inhibitors can improve multiple clinically relevant TED outcomes compared with placebo, while also increasing adverse events. The finding of greater proptosis-reduction efficacy in acute active disease may help frame expectations across disease activity states. Balancing these benefits against treatment-related harms is important when considering disease-modifying therapy.
What to keep in mind
The analysis included 7 trials and 669 patients; the abstract reports heterogeneity-related analyses but does not provide further detail on limitations.