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Review
. 2026 Feb 1;18(2):e102775.
doi: 10.7759/cureus.102775. eCollection 2026 Feb.

Association Between Teprotumumab and Hearing Impairment: A Meta-Analysis

Maxim J Barnett  1 , Maria deMelo  1 , Maria Rego  1 , Carlo Casipit  1
Affiliations
Review

Association Between Teprotumumab and Hearing Impairment: A Meta-Analysis

Maxim J Barnett et al. Cureus. .

Abstract

Teprotumumab is a medication for thyroid eye disease. We conducted a review of studies assessing teprotumumab for thyroid eye disease treatment from MEDLINE (Medical Literature Analysis and Retrieval System Online) and CINHAL (Cumulative Index to Nursing and Allied Health Literature) from inception to September 20, 2025. The outcome of interest was hearing impairment. We included nine studies (four randomized controlled trials and five observational studies). The randomized controlled trials included 153 teprotumumab-treated patients. Using both broad and strict definitions of hearing loss, teprotumumab continued to demonstrate a statistically significant increased risk of hearing impairment (Broad: risk ratio (RR) 3.57, 95% CI 1.27-9.97; Strict: RR 5.23, 95% CI 1.40-19.57). Observational studies included over 2,000 patients treated with teprotumumab. Using the broad definition, the RR amongst observational studies was 2.78 (95% CI, 2.38-3.24); using the strict definition, the RR amongst observational studies was 2.76 (95% CI, 2.30-3.31). Sensitivity analyses were performed, with results remaining statistically significant, without heterogeneity or publication bias. Teprotumumab is associated with hearing impairment using broad and strict definitions, consistent amongst both RCTs and observational studies. Further research is required to address potential treatment options, the likelihood of recurrence with retreatment, and the chance of recovery.

Keywords: exophthalmos; graves' orbitopathy; tepezza; teprotumumab; thyroid eye disease.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: As a potential conflict of interest, Dr. Barnett reports prior authorship of a retrospective analysis on teprotumumab and hearing impairment published in 2025, which is cited in this meta-analysis; however, there was no shared funding or financial relationship related to the current study.

Figures

Figure 1
Figure 1. PRISMA flow chart of selection of studies
PRISMA: Preferred Reporting Items for Systematic reviews and Meta-Analyses
Figure 2
Figure 2. Risk of bias for included randomized controlled trials
Figure 3
Figure 3. Forest plot of randomized controlled trials using “broad” definition
Figure 4
Figure 4. Forest plot of randomized controlled trials using “strict” definition
Figure 5
Figure 5. Forest plot of observational studies using “broad” definition
Figure 6
Figure 6. Forest plot of observational studies using “strict” definition
Figure 7
Figure 7. Cochlear sensory cells and mechanism of action of teprotumumab
Image Source: Xu et al., 2025 [30]; Published under the terms of CC BY 4.0: Attribution 4.0 International Deed
See this image and copyright information in PMC

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