How do you sequence IV steroids and IGF-1R blockade when inflammatory activity and proptosis coexist in a patient with active thyroid eye disease (TED)?

I don't find that steroids are actually necessary for patients who are receiving IGF1R inhibitors. The inflammation typically responds quite well to Teprotumumab (haven't tried Veligrotug yet), so steroids don't really add any benefit. These days, I only use IV steroids for patients who can't get IG...

IGF-1R blockade with either teprotumumab (Tepezza) or veligrotug (Lumvoa, recently FDA-approved) has demonstrated efficacy without concomitant glucocorticoid therapy in the pivotal clinical trials evaluating these agents. IV glucocorticoid regimens, such as the EUGOGO-recommended methylprednisolone ...

IGF-IR blockade has strong data indicating that it treats both the inflammatory features of TED, when present, as well as structural changes from the disease process. In patients with both inflammation and proptosis, my clinical experience and the literature point to the limited utility of corticost...