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Infusion Milestone: Breakthrough TED Treatment During Pandemic

Home infusion of teprotumumab-trbw (Tepezza), a breakthrough treatment for thyroid eye disease, was found to effectively minimize the chance of COVID-19 infection.

In 2020, Chartwell Pennsylvania, LP, part of CarepathRx, was the first provider in the nation to administer teprotumumab-trbw (Tepezza), a breakthrough medication for the treatment of thyroid eye disease (TED), in a home-infusion setting—an incredible achievement in the treatment of a potentially debilitating autoimmune disease.

“In the wake of the COVID-19 outbreak, access to home infusion therapy is more important than ever,” said CarepathRx Specialty Pharmacy & Infusion Solutions COO David Benedict, PharmD, BCPS. “Many home infusion patients are considered at higher risk of severe reaction to COVID-19 due to age, chronic illness, and/or an immunocompromised condition. Treatment at home effectively minimizes the chance of infection for both patients and staff.”

Infusion Milestone

Teprotumumab-trbw is administered once every 3 weeks for a total of 8 infusions. Patients are screened on a case-by-case basis to determine their eligibility to receive the first dose in either a controlled setting, such as a hospital or outpatient infusion center, or in the home.

A number of factors play a role in determining whether a patient is a good candidate to receive the initial infusion in the home, including comorbidities such as diabetes or irritable bowel syndrome (IBS), and other factors such as age, medication allergies, and whether the patient is a smoker or plans to become pregnant.

The first patient to receive the initial dose in the home setting, representing an important milestone in the teprotumumab-trbw home infusion process, took place just 2 weeks into the state-mandated quarantine. In addition to easing the burden of care placed on hospitals and other health care facilities, home infusion creates a unique level of convenience for the patient and caregiver.


Approved on January 21, 2020, teprotumumab-trbw is the first and only FDA-approved medicine for the treatment of TED, a rare and serious autoimmune disease with vast variability in duration and symptom presentation. The term “thyroid eye disease” is often used in conjunction with Graves’ disease, an autoimmune disorder that causes hyperthyroidism, although the two are sometimes distinct conditions.

TED can lead to a wide array of vision-threatening impairments, such as dry eye disease; diplopia, which is misalignment of the eyes; visual acuity and visual field defects; facial disfigurement; and optic neuropathy in 6% to 9% of patients, according to statistics from manufacturer Horizon Therapeutics.

Teprotumumab-trbw has a novel mechanism designed to block the insulin-like growth factor-1 receptor (IGF-1R), which is the key mediator of TED. The treatment received Priority Review, Orphan Drug, Fast Track, and Breakthrough Therapy designations from the FDA.

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