Recent Advances of Second-Line Targeted Biopharmaceutical Therapies in Thyroid Associated Ophthalmopathy

Intravenous glucocorticoids are the clinically preferred treatment for moderate-to-severe thyroid-associated ophthalmopathy. However, the serious adverse effects following intravenous glucocorticoids and the risks posed by the cumulative doses cannot be overlooked. Moreover, it is found to be ineffective in the treatment of many patients with severe thyroid-associated ophthalmopathy. Consequently, the development of superior alternative therapies is imminent. Recent advancements in the identification of multiple autoimmune-related targets have led to the utilization of novel antibodies such as rituximab, teprotumumab, tocilizumab, and batocliumab in clinical settings. They have shown great potential in enhancing the therapeutic effect of thyroid-associated ophthalmopathy, minimizing adverse effects, and shortening treatment duration. Additionally, small molecule targeted drugs, such as single or double aptamers are rapidly developed to target the inflammatory microenvironment. In this review, the advancements in second-line targeted therapeutic options for thyroid-associated ophthalmopathy, providing a clinical rationale for immune mechanism-based treatment of thyroid-associated ophthalmopathy in the era of precision medicine are reported.