Private Tepezza (teprotumumab) IV infusion cost UK 2026 — active thyroid eye disease

What is Tepezza (teprotumumab)?

Tepezza (teprotumumab-trbw, originally developed by Genmab and River Vision, licensed to Horizon Therapeutics, now Amgen following Horizon's acquisition in 2023) is a fully human IgG1 kappa monoclonal antibody that binds the extracellular domain of the insulin-like growth factor 1 receptor (IGF-1R) with high affinity. In thyroid eye disease (Graves orbitopathy), the IGF-1 receptor is over-expressed on orbital fibroblasts and forms a functional signalling complex with the thyrotropin (TSH) receptor; the auto-immune TSH-receptor antibodies of Graves disease drive expansion of the orbital fat and extra-ocular muscles via this IGF-1R / TSHR cross-talk. By blocking IGF-1R signalling, teprotumumab reduces hyaluronan production, fibroblast proliferation and adipogenesis in the retro-orbital space, leading to measurable reductions in proptosis on Hertel exophthalmometry, extra-ocular muscle volume on imaging, clinical activity score (CAS) and diplopia.

Tepezza is delivered as an intravenous infusion every 3 weeks for 8 doses over approximately 21 to 24 weeks. The first dose is 10 mg/kg body weight; subsequent doses (infusions 2 through 8) are 20 mg/kg. Each infusion runs over approximately 60 to 90 minutes with cardiopulmonary monitoring; the patient is observed for at least 30 minutes after the infusion ends. The standard course is 8 infusions; there is no maintenance dosing in the original label. The OPTIC-X open-label extension demonstrated that a second 8-infusion course can produce additional response in patients with incomplete response or relapse. Each visit is approximately 2.5 to 3.5 hours in total and same-day discharge is routine. The drug is supplied by Horizon Therapeutics / Amgen in 500 mg single-use vials; in the UK in 2026 it is imported through the unlicensed Specials / named-patient route.

Tepezza received FDA approval in January 2020 for the treatment of thyroid eye disease, on the basis of the phase 2 trial (Smith et al., NEJM 2017) and the OPTIC phase 3 trial (Douglas et al., NEJM 2020). It was the first medicine ever approved for thyroid eye disease anywhere in the world. Horizon Therapeutics (and subsequently Amgen) did not pursue a European Medicines Agency or UK MHRA marketing authorisation submission. Teprotumumab is therefore not on the EMA or MHRA register. UK private access is via the unlicensed Specials / named-patient import route under MHRA Specials guidance, with the prescribing consultant taking individual clinical responsibility. NICE Technology Appraisal for routine NHS commissioning is in scoping stage as of May 2026; the standard NHS first-line therapy remains pulsed intravenous methylprednisolone per the EUGOGO consensus, with second-line tocilizumab or rituximab on a named-patient basis at tertiary thyroid eye disease centres.

UK 2026 Tepezza pricing, in detail

Private Tepezza pricing in the UK is driven by the procurement cost of teprotumumab via the Specials importation route (the principal pricing component plus VAT and Specials importer margin; the body-weight dose for a 70 kg adult is 700 mg first infusion and 1,400 mg subsequent), the CQC-registered infusion suite overhead, the consultant oculoplastic and endocrinology multi-disciplinary input, and the baseline and surveillance audiometric and glycaemic monitoring built into the pathway. Most reputable London providers bundle these components into an all-inclusive per-infusion fee and quote the full 8-infusion course cost up-front.

For related thyroid eye disease pricing and pathways see our thyroid eye disease overview, our orbital decompression surgery, our private squint surgery London, our eyelid retraction surgery and our Graves disease guide.

What a quality UK Tepezza TED package should include

• Consultant oculoplastic surgeon with TED subspecialty interest — a UK GMC-registered consultant ophthalmologist with documented oculoplastic and orbital fellowship, an active multi-disciplinary thyroid eye disease practice, and an established Specials / named-patient pathway for teprotumumab.
• Multi-disciplinary input — consultant endocrinologist (thyroid function, restoration of euthyroidism, HbA1c optimisation, diabetic management during therapy), ENT / audiology (baseline and surveillance pure-tone audiometry and tympanometry), and where indicated neuro-radiology (orbital MRI interpretation), neuro-ophthalmology (dysthyroid optic neuropathy) and clinical psychology.
• Full pre-treatment work-up — best corrected visual acuity, colour vision, pupillary assessment for relative afferent pupillary defect, Hertel exophthalmometry, slit-lamp, IOP including on-upgaze, dilated fundoscopy with optic disc photography, OCT optic nerve head and macula, visual fields, orthoptic assessment with Hess chart and field of binocular single vision, EUGOGO clinical activity score, photographic documentation, orbital MRI, TSH / free T4 / free T3 / TRAb / HbA1c / fasting glucose / full blood count / liver and renal function, baseline pure-tone audiometry and tympanometry, pregnancy testing for women of childbearing potential.
• CQC-registered infusion suite — with cardiopulmonary monitoring, IV access kit, on-site resuscitation equipment, dedicated infusion chairs and the capability to manage infusion reactions including anaphylaxis.
• Documented Specials importation chain-of-custody — written agreement with a CQC- and MHRA-licensed Specials importer or under a Specials Import Licence; batch and expiry documented for every dose; clinical responsibility of the prescribing consultant recorded.
• Body-weight-calculated dosing — 10 mg/kg first infusion, 20 mg/kg subsequent infusions; weight checked at every visit (the dose is body-weight calculated and weight changes during treatment are common).
• Structured 3-weekly infusion cadence — 8 infusions over 21 to 24 weeks with minor scheduling flexibility (plus or minus 4 days).
• Audiometric surveillance protocol — minimum baseline, mid-course (around infusion 4) and end-of-course; many UK centres in 2026 perform audiometry before every infusion. Patient-completed symptom checklist at every visit (any new tinnitus, autophony, ear fullness, hearing change).
• Glycaemic surveillance protocol — capillary glucose at every infusion visit; fasting glucose and HbA1c at mid-course and end-of-course; joint endocrinology review for diabetic patients with intensification of diabetic therapy as needed.
• Pregnancy prevention counselling — teprotumumab is contraindicated in pregnancy; effective contraception is required during treatment and for at least 6 months after the final infusion; pregnancy testing as appropriate.
• Smoking cessation and euthyroid maintenance — smoking is the single most important modifiable factor in TED outcome; restoration and maintenance of euthyroidism is required throughout treatment.
• Documented end-of-course response review — repeat Hertel, orthoptics, CAS, photographic documentation, audiometry, fasting glucose / HbA1c and (where indicated) repeat orbital MRI 6 to 8 weeks after the final infusion.
• Onward orbital rehabilitation pathway — access to orbital decompression, squint and eyelid surgery 6 to 12 months post-treatment once disease is reliably inactive.

Evidence base — what the trials show

Tepezza has the most robust controlled-trial evidence base of any therapy for thyroid eye disease. The headline trials and key real-world series should be reviewed together:

• Phase 2 trial (Smith TJ et al., NEJM 2017; n=88) — randomised double-masked placebo-controlled trial of teprotumumab 10 mg/kg followed by 20 mg/kg every 3 weeks for 8 infusions versus placebo in active moderate-to-severe TED. Primary endpoint of response (CAS reduction ≥ 2 and proptosis reduction ≥ 2 mm) at week 24 was met by 69 per cent of teprotumumab patients versus 20 per cent placebo. Mean proptosis reduction approximately 2.5 to 3 mm versus 0.2 mm placebo.
• OPTIC phase 3 trial (Douglas RS et al., NEJM 2020; n=83 active / 41 placebo) — randomised double-masked placebo-controlled trial confirming the phase 2 findings. Primary endpoint of proptosis response (≥ 2 mm reduction in the study eye without similar deterioration in the fellow eye) at week 24: 83 per cent teprotumumab versus 10 per cent placebo. Mean proptosis reduction approximately 2.8 to 3 mm. Diplopia response 68 per cent versus 29 per cent. CAS of 0 or 1 in 59 per cent versus 21 per cent. GO-QoL favoured teprotumumab.
• OPTIC-X open-label extension and re-treatment study — participants who had not responded to placebo in OPTIC, or who had responded to teprotumumab and subsequently relapsed, received an 8-infusion course of teprotumumab. Approximately 60 to 70 per cent of placebo non-responders achieved proptosis response on subsequent active treatment; a similar proportion of relapsers achieved additional response with re-treatment.
• Ugradar et al. Eye 2022 (chronic / inactive TED) — retrospective real-world series of teprotumumab in patients with chronic / inactive TED (duration more than 12 months, CAS less than 4). Mean proptosis reduction approximately 2.6 mm; the response is lower and less predictable than in active TED but clinically meaningful in many chronic-phase patients.
• Diniz et al., Ophthalmic Plastic and Reconstructive Surgery; multi-centre real-world experience — broadly confirms OPTIC efficacy in real-world clinical practice with broadly similar response rates and a similar adverse event profile.
• Audiometric surveillance studies (Belinsky et al., Sears et al., Bartalena et al.) — prospective audiometric surveillance during teprotumumab therapy demonstrates any auditory symptom in 20 to 65 per cent of treated patients, clinically significant sensorineural hearing loss in 10 to 20 per cent, often at higher frequencies first, and sometimes permanent. This mandates the structured audiometric surveillance built into the UK private pathway.
• Tocilizumab evidence (Perez-Moreiras et al. 2018) — a small RCT of intravenous tocilizumab (8 mg/kg every 4 weeks for 16 weeks) demonstrated significant CAS and proptosis benefit in steroid-refractory active TED, supporting tocilizumab as a second-line biological alternative.
• Rituximab evidence (Stan et al. 2015; Salvi et al. 2015) — conflicting RCT results; tends to be less effective in older patients, more effective in younger patients with shorter disease duration. Now generally reserved for younger highly active steroid-refractory cases.
• EUGOGO consensus guidelines (latest edition) — pulsed intravenous methylprednisolone (cumulative 4.5 g over 12 weeks) is the European / UK standard first-line therapy for active moderate-to-severe TED, with addition of mycophenolate, second-line biologicals (teprotumumab, tocilizumab, rituximab), orbital radiotherapy, and surgical rehabilitation in the chronic phase.
• FDA Briefing Document January 2020 — the FDA approved Tepezza on the basis of the phase 2 and OPTIC trials. Horizon Therapeutics did not pursue an EMA submission; Amgen (post-2023 acquisition) has not signalled a UK MHRA submission as of May 2026.

In short: Tepezza is the most effective single therapy for active moderate-to-severe TED ever subjected to placebo-controlled RCT, with approximately 83 per cent proptosis response, approximately 3 mm mean reduction (comparable to surgical orbital decompression) and meaningful diplopia and CAS response. The principal counselling points are the ototoxicity signal (10 to 65 per cent of patients), the hyperglycaemia signal (especially in diabetics), the pregnancy contraindication, the unlicensed Specials route status in the UK in 2026, and the very high cost relative to NHS-commissioned alternatives. The choice between Tepezza, IV steroids, tocilizumab, rituximab and surgical decompression should be individualised by a multi-disciplinary thyroid eye disease team.

Tepezza versus IV steroids versus orbital decompression

Honest head-to-head comparison of the principal TED treatment options in 2026:

• Tepezza (teprotumumab, IGF-1R inhibitor; Horizon / Amgen) — FDA approved Jan 2020, UK MHRA unlicensed (Specials route). Targets the IGF-1R / TSHR pathway driving orbital tissue remodelling. OPTIC NEJM 2020: 83 per cent proptosis responders, mean reduction approximately 3 mm; meaningful diplopia and CAS response; durable but re-treatment possible. Safety: ototoxicity, hyperglycaemia, muscle spasm, pregnancy contraindication. Cost: approximately £124,000 to 204,000 for the 8-infusion course. Mechanically superior for proptosis and diplopia versus all alternatives.
• IV methylprednisolone per EUGOGO (NHS first-line) — MHRA-licensed steroid use; NHS-commissioned. 12-week pulsed protocol, cumulative 4.5 g. Improves CAS and inflammatory signs but only modest effect on proptosis (typically less than 1 mm) and limited effect on diplopia. Cheap, available, time-tested. Safety: weight gain, hyperglycaemia, mood disturbance, sleep, osteoporosis with high cumulative dose, transient hypertension. The right first-line for most patients with first-presentation active moderate-to-severe TED.
• Mycophenolate (added to IV methylprednisolone) — the MINGO RCT (Kahaly et al.) supports addition of mycophenolate to IV methylprednisolone with improved response rate. Oral, well-tolerated. Standard adjunct in many UK tertiary centres in 2026.
• Tocilizumab (anti-IL-6R) — off-label biological; small RCT evidence (Perez-Moreiras 2018) supports use in steroid-refractory active TED. IV infusions every 4 weeks. Available at NHS tertiary centres on a named-patient basis; cheaper than Tepezza. Reasonable alternative for steroid-refractory disease where Tepezza is unaffordable or contraindicated.
• Rituximab (anti-CD20) — conflicting RCT data; generally reserved for younger active patients. NHS access on named-patient basis at tertiary centres.
• Orbital radiotherapy (10 to 20 Gy fractionated) — useful adjunct, particularly for diplopia and inflammation; effect develops over 3 to 6 months. NHS-commissioned at tertiary centres. Cataract risk is small but non-zero. Diabetic retinopathy is a relative contraindication.
• Orbital decompression surgery (chronic-phase definitive) — medial wall, orbital floor and / or lateral wall decompression with or without fat decompression. Proptosis reduction 4 to 7 mm per orbit, immediate and durable. The procedure of choice for chronic / inactive proptosis-dominant TED, particularly where Tepezza is unaffordable, contraindicated, or has produced only partial response. NHS-commissioned at tertiary centres but with long waits; widely available privately. See our orbital decompression surgery guide.
• Squint surgery and eyelid surgery — for residual diplopia (adjustable squint surgery), upper or lower lid retraction (lid lengthening), or fat prolapse (blepharoplasty) in the chronic phase. Sequenced after orbital decompression if both indicated.
• Smoking cessation, euthyroid maintenance, selenium for mild disease — the cheapest and most important interventions. Selenium 200 mcg daily for 6 months has evidence in mild TED (Marcocci et al.).

Pragmatic 2026 UK pathway: IV methylprednisolone per EUGOGO first line for most patients with first-presentation active moderate-to-severe TED, with addition of mycophenolate per MINGO. Teprotumumab considered second-line for steroid-refractory, steroid-intolerant or proptosis-dominant cases, weighed against tocilizumab on cost and access grounds. Orbital decompression surgery is the definitive choice for chronic / inactive proptosis-dominant disease and remains an excellent option when Tepezza is unaffordable. The decision should be made by a multi-disciplinary thyroid eye disease team in light of disease activity, severity, patient priorities, comorbidities and cost.

Who is Tepezza the right choice for?

Tepezza is FDA-approved for thyroid eye disease in adults. In the UK in 2026 it is accessed via the unlicensed Specials / named-patient import route. Ideal candidacy:

• Active moderate-to-severe thyroid eye disease — clinical activity score ≥ 4 by EUGOGO 7-point or 10-point scale; disease duration typically less than 9 months (the OPTIC trial population).
• Significant proptosis — Hertel exophthalmometry typically more than 2 mm above the upper limit for the patient's ethnicity, particularly when proptosis is the dominant complaint or is causing exposure keratopathy.
• Steroid-refractory or steroid-intolerant disease — persistent disease activity, persistent proptosis or persistent diplopia after a standard EUGOGO IV methylprednisolone course, or significant side-effects preventing completion.
• Diplopia in active disease — particularly where diplopia is functionally disabling.
• Selected sight-threatening features — dysthyroid optic neuropathy after or alongside high-dose IV methylprednisolone where surgical decompression is undesirable or premature.
• Established euthyroidism and active smoking cessation — restoration of euthyroidism is required before starting; smoking cessation is critically important and is the single most important modifiable factor.
• Acceptable audiometric baseline — baseline pure-tone audiometry within or near population norms; significant pre-existing sensorineural hearing loss is a relative contraindication.
• Acceptable glycaemic baseline — HbA1c well-controlled if diabetic; non-diabetic patients with normal fasting glucose.
• Effective contraception in women of childbearing potential — required during treatment and for at least 6 months after the final infusion.
• Ability to commit to the 24-week course — 8 infusions over 21 to 24 weeks plus audiometric, glycaemic and clinical surveillance.
• Informed acceptance of the unlicensed Specials route — explicit informed consent for an unlicensed medicine with full understanding of FDA approval, absence of MHRA licensing and Specials importation.
• Selected chronic / inactive proptosis-dominant cases — weighed against orbital decompression surgery; honest off-trial counselling required.

Tepezza is not the right choice for: patients with chronic stable disease where orbital decompression provides definitive, immediate and more cost-effective proptosis reduction; patients with significant pre-existing sensorineural hearing loss; patients with poorly controlled diabetes or HbA1c not amenable to pre-treatment optimisation; women who are pregnant, breastfeeding or planning pregnancy within 6 months of the final infusion; patients with active inflammatory bowel disease; patients with active malignancy where IGF-1R blockade is a concern; patients unable to commit to the 24-week course and surveillance plan; or patients unable to give informed consent for an unlicensed Specials medicine.

NHS versus private Tepezza access

Tepezza is not licensed by the UK MHRA in 2026 and is not routinely commissioned on the NHS. UK NHS active TED pathways in 2026 follow the EUGOGO consensus and the British Thyroid Association / Royal College of Physicians / Royal College of Ophthalmologists joint guidance: pulsed intravenous methylprednisolone (cumulative dose 4.5 g over 12 weeks) is first line; addition of oral mycophenolate per MINGO is increasingly standard; second-line tocilizumab (anti-IL-6R) or rituximab (anti-CD20) is available on a named-patient basis at tertiary thyroid eye disease centres; orbital radiotherapy is commissioned for selected patients; orbital decompression, squint and eyelid rehabilitation surgery are commissioned in the chronic phase. Smoking cessation, restoration of euthyroidism and selenium for mild disease are universally recommended. Selected NHS tertiary centres can submit individual funding requests (IFR) for teprotumumab, but approvals are rare in 2026.

Private Tepezza access in 2026 is via the unlicensed Specials / named-patient import route at selected CQC-registered London multi-disciplinary thyroid eye disease centres. The pathway requires explicit informed consent for an unlicensed medicine, documented Specials importation chain-of-custody, multi-disciplinary input (oculoplastic, endocrinology, ENT / audiology) and structured audiometric and glycaemic surveillance. NICE Technology Appraisal for teprotumumab is in scoping stage as of May 2026; until NICE issues positive guidance or Amgen submits to the MHRA, the private route remains the principal access channel.

For patients with severe active proptosis-dominant TED, steroid-refractory or steroid-intolerant disease, the private Specials route is reasonable provided the patient can commit to the 24-week course and absorb the cost. For patients with milder active disease responding well to IV methylprednisolone, those with predominantly chronic / inactive disease where orbital decompression is more cost-effective, or those unable to absorb the cost, the NHS pathway remains entirely reasonable. The choice should be discussed with the multi-disciplinary thyroid eye disease team on an individualised basis.

Private medical insurance and Tepezza

Almost certainly no cover for the drug cost. UK private medical insurers (Bupa, AXA Health, Aviva, Vitality, WPA) do not generally cover unlicensed Specials medicines as a matter of standard policy, and teprotumumab is currently unlicensed by the MHRA. The underlying consultant oculoplastic and endocrinology assessment, orbital MRI / CT, audiometric and glycaemic surveillance, and the IV infusion administration itself may be covered under standard ophthalmic, endocrine or chronic disease benefits with pre-authorisation, but the teprotumumab vial component (the principal cost driver, typically more than 95 per cent of the total course cost) is virtually never covered. Some insurers will consider a discretionary appeal where the consultant provides a comprehensive case demonstrating failure or contraindication of NHS-commissioned alternatives (IV methylprednisolone, tocilizumab, rituximab, orbital decompression) and overwhelming clinical justification for Tepezza, but approvals remain rare. The clinic team prepares the pre-authorisation package, liaises with the insurer, and clearly itemises the insured and self-pay components before the first infusion is scheduled.

Risks of Tepezza infusions

Honest counselling on Tepezza-specific and standard IV monoclonal-antibody risks:

• Ototoxicity / hearing loss (the principal Tepezza-specific risk) — approximately 10 per cent of patients in OPTIC had a documented auditory adverse event; subsequent prospective audiometric surveillance studies (Belinsky et al., Sears et al., Bartalena et al.) report any auditory symptom in 20 to 65 per cent of treated patients (tinnitus, autophony, ear fullness, hearing loss, patulous Eustachian tube) and clinically significant sensorineural hearing loss in approximately 10 to 20 per cent, often starting at higher frequencies. Some hearing loss is permanent. Mandatory baseline pure-tone audiometry and structured surveillance; prompt discontinuation for clinically significant new sensorineural hearing loss.
• Hyperglycaemia — approximately 10 per cent of non-diabetic patients develop new hyperglycaemia; approximately 30 per cent of diabetic patients develop worsening hyperglycaemia and may require intensification of diabetic therapy. Severe uncontrolled hyperglycaemia warrants discontinuation. Mandatory baseline HbA1c and fasting glucose; structured surveillance.
• Muscle spasm and cramps — approximately 25 per cent of patients; usually mild to moderate and self-limiting; managed with hydration, electrolyte review and reassurance.
• Nausea, diarrhoea and dysgeusia — approximately 12 to 15 per cent each; usually mild and self-limiting.
• Alopecia and dry skin — approximately 13 per cent reversible hair loss; reverses over weeks to months after the final infusion.
• Fatigue — common but usually manageable; some patients require schedule adjustments around work commitments.
• Infusion reactions — approximately 4 per cent of infusions; usually mild (chills, headache, transient hypertension or hypotension); rarely severe; managed with infusion rate adjustment and premedication.
• Amenorrhoea and menstrual disturbance — reported in pre-menopausal women; usually reverses after the final infusion.
• Pregnancy contraindication — animal data show foetal harm; no human data; effective contraception required during treatment and for at least 6 months after the final infusion.
• Inflammatory bowel disease flare — relative contraindication; pre-existing IBD should be quiescent on adequate maintenance therapy before considering Tepezza.
• Malignancy concern — relative contraindication in active malignancy where IGF-1R blockade may interact with cancer biology; multi-disciplinary discussion required.
• Unlicensed Specials route risk — the prescribing consultant takes individual clinical responsibility; the patient must understand and consent to the unlicensed route, batch and importation arrangements.
• Cost-effectiveness consideration — for chronic stable proptosis-dominant disease, orbital decompression surgery may provide more cost-effective and more immediate proptosis reduction (4 to 7 mm per orbit) than a Tepezza course.

After your Tepezza course

Each individual infusion visit takes approximately 2.5 to 3.5 hours total (pre-infusion review, IV cannulation, infusion over 60 to 90 minutes, post-infusion observation). Same-day discharge is routine. Mild fatigue, transient muscle cramps and minor infusion-related symptoms are common in the 24 to 72 hours after each infusion and do not require treatment. The patient should not drive home from the first infusion; subsequent infusions are usually fine to drive home from once cleared, provided no adverse infusion reactions and no fatigue.

New onset tinnitus, hearing change, autophony, ear fullness, severe muscle cramps, severe nausea, severe hyperglycaemia symptoms (extreme thirst, polyuria, weight loss, confusion), or symptoms suggestive of infusion reaction or anaphylaxis in the days after an infusion should prompt urgent contact with the clinic (0800 852 7782). Audiometry will be repeated promptly for new auditory symptoms; capillary glucose monitoring will be reinforced for hyperglycaemia symptoms.

End-of-course response review at approximately 6 to 8 weeks after the 8th infusion: repeat Hertel exophthalmometry, photographic documentation, orthoptic assessment with Hess chart and field of binocular single vision, clinical activity score, audiometry, fasting glucose and HbA1c, and (where indicated) repeat orbital MRI. Many patients see continued proptosis reduction for several weeks after the final infusion. Long-term: 6-monthly oculoplastic surveillance for at least 2 years post-treatment; coordinated endocrinology surveillance; annual audiometry for longer-term ototoxicity surveillance. Smoking cessation maintained. Euthyroidism maintained. Onward orbital rehabilitation surgery (orbital decompression, squint, eyelid lengthening, blepharoplasty) is planned 6 to 12 months after the final infusion once disease is reliably inactive. OPTIC-X-style re-treatment is considered for patients with incomplete response or recrudescence.

How to choose a UK clinic for Tepezza

• Consultant oculoplastic credentials — UK GMC registration with oculoplastic and orbital fellowship; British Oculoplastic Surgery Society (BOPSS) membership; documented multi-disciplinary thyroid eye disease practice; an established Specials / named-patient pathway for teprotumumab.
• Multi-disciplinary team — documented integration with consultant endocrinology, ENT / audiology, neuro-radiology and (where needed) neuro-ophthalmology, clinical psychology and orbital surgery.
• CQC-registered infusion suite — cardiopulmonary monitoring, IV access kit, on-site resuscitation, dedicated infusion chairs and capability to manage infusion reactions including anaphylaxis.
• Audiometry on-site or close partnership — baseline and structured surveillance pure-tone audiometry and tympanometry; clear protocol for action if new sensorineural hearing loss is detected.
• Specials importation chain-of-custody — documented relationship with a CQC- and MHRA-licensed Specials importer; batch and expiry documentation for every dose.
• Itemised written quotation — consultant fee, imaging, audiometry, the teprotumumab drug, the IV infusion administration and the surveillance plan should all be itemised; total course price clearly stated up-front; written quotation valid 60 days.
• Structured 3-weekly cadence with scheduling flexibility — protected slot for the full 24-week course; minor scheduling flexibility (plus or minus 4 days) to accommodate patient travel and work.
• Pre-treatment euthyroidism and smoking cessation support — the clinic should actively support these via the multi-disciplinary team.
• Onward orbital rehabilitation pathway — access to orbital decompression, squint and eyelid surgery 6 to 12 months post-treatment at the same site or a partner site.
• Continuity of named consultant — the consultant who consents and starts treatment should lead the long-term follow-up.

Frequently asked questions

How much does a private Tepezza course cost in the UK in 2026?

UK 2026 self-pay private Tepezza is £15,500–£25,500 per infusion, all-inclusive at CQC-registered London infusion centres. The full 8-infusion course over approximately 24 weeks totals £124,000–£204,000. The teprotumumab drug-vial cost (Specials import) is the dominant pricing component, typically more than 95 per cent of the total course cost.

What is Tepezza (teprotumumab) and how does it work?

Tepezza is a fully human IgG1 monoclonal antibody (Horizon Therapeutics / Amgen) that binds the insulin-like growth factor 1 receptor (IGF-1R) on orbital fibroblasts and lymphocytes. By blocking the IGF-1R / TSHR functional complex that drives orbital tissue remodelling in TED, teprotumumab reduces hyaluronan production, fibroblast proliferation and adipogenesis in the retro-orbital space, leading to measurable reductions in proptosis, diplopia and clinical activity score. Delivered as 8 IV infusions every 3 weeks (10 mg/kg first, 20 mg/kg subsequent).

Is Tepezza approved in the UK?

No. The FDA approved Tepezza in January 2020. Horizon / Amgen did not pursue an EMA or MHRA submission. The UK MHRA has not licensed teprotumumab. UK private access in 2026 is via the unlicensed Specials / named-patient import route under MHRA Specials guidance. NICE Technology Appraisal is in scoping stage as of May 2026.

What did OPTIC show?

OPTIC (Douglas RS et al., NEJM 2020; n=83 active / 41 placebo) demonstrated 83 per cent proptosis responders (≥ 2 mm reduction at week 24) on teprotumumab versus 10 per cent on placebo. Mean proptosis reduction approximately 3 mm. Diplopia response 68 per cent versus 29 per cent. CAS of 0 or 1 in 59 per cent versus 21 per cent. The phase 2 trial (Smith TJ et al., NEJM 2017) showed similar magnitude of effect.

Does the NHS pay for Tepezza?

No. Tepezza is not commissioned on the NHS in 2026 because the MHRA has not licensed it. NHS active TED pathways follow EUGOGO: pulsed IV methylprednisolone first line, with mycophenolate, tocilizumab, rituximab, orbital radiotherapy and surgical rehabilitation as appropriate. Individual funding requests for teprotumumab are rarely approved.

Tepezza versus IV steroids — which is better?

Indirect comparison only. IV methylprednisolone per EUGOGO (cumulative 4.5 g over 12 weeks) is the NHS / European standard first-line therapy: improves CAS and inflammation but only modest effect on proptosis (less than 1 mm). Tepezza targets IGF-1R / TSHR and shows substantially larger proptosis reduction (approximately 3 mm) and better diplopia response, but is unlicensed, only privately available and approximately 30 to 50 times more expensive. A pragmatic UK pathway is steroids first line, with Tepezza reserved for steroid-refractory, steroid-intolerant or proptosis-dominant cases.

What is the hearing loss risk?

The principal Tepezza-specific safety signal. Prospective audiometric surveillance studies report any auditory symptom in 20 to 65 per cent of treated patients, and clinically significant sensorineural hearing loss in 10 to 20 per cent, sometimes permanent. Baseline pure-tone audiometry, structured surveillance and prompt discontinuation for new sensorineural loss are mandatory.

What is the hyperglycaemia risk?

Approximately 10 per cent of non-diabetic patients develop new hyperglycaemia; approximately 30 per cent of diabetic patients develop worsening hyperglycaemia and may need intensification of diabetic therapy. Mandatory baseline HbA1c and fasting glucose; surveillance throughout treatment; joint endocrinology input for diabetic patients.

Can I have Tepezza if I am pregnant or planning pregnancy?

No. Animal data show foetal harm; no human safety data. Effective contraception is required throughout treatment and for at least 6 months after the final infusion. Pregnancy testing as appropriate before starting and during treatment.

Will my private medical insurance pay for Tepezza?

Almost certainly not for the drug cost, because most insurers do not cover unlicensed Specials medicines. The consultant assessment, imaging, audiometry and infusion administration may be covered with pre-authorisation; the drug-vial cost (more than 95 per cent of the total) is virtually never covered. The clinic team prepares the pre-authorisation package and itemises the components.

How often will I need infusions and how long is the course?

Standard course is 8 infusions every 3 weeks over approximately 21 to 24 weeks. First infusion 10 mg/kg, infusions 2 through 8 are 20 mg/kg. Each infusion visit takes 2.5 to 3.5 hours. OPTIC-X-style re-treatment can be considered for incomplete responders or relapsers.

What are the alternatives to Tepezza?

EUGOGO IV methylprednisolone (NHS first-line), mycophenolate, tocilizumab, rituximab, orbital radiotherapy, orbital decompression surgery (definitive for chronic proptosis), squint and eyelid rehabilitation surgery, smoking cessation, selenium for mild disease. See our thyroid eye disease overview and orbital decompression surgery guide.

Can I have Tepezza if my TED is chronic or inactive?

Possibly. The OPTIC trial enrolled active disease only (CAS ≥ 4, duration less than 9 months). Real-world series (Ugradar et al., Eye 2022) report meaningful proptosis reduction in chronic / inactive TED, of the order of 2 to 3 mm, but with lower and less predictable response. Chronic-phase candidates should also be assessed against orbital decompression which provides immediate definitive proptosis reduction.

Methodology and sources

This UK 2026 patient pricing and pathway guide was prepared by the Eye Surgery Clinic editorial team and reviewed by a UK GMC-registered consultant ophthalmologist with oculoplastic and thyroid eye disease subspecialty interest. Pricing reflects a CQC-registered UK oculoplastic and infusion-suite sample audited against published 2025 to 2026 self-pay tariffs from the major UK private TED providers and the Horizon / Amgen Specials importation channel. Clinical statements are anchored on:

• Smith TJ, Kahaly GJ, Ezra DG, et al. Teprotumumab for thyroid-associated ophthalmopathy. New England Journal of Medicine 2017.
• Douglas RS, Kahaly GJ, Patel A, et al. Teprotumumab for the treatment of active thyroid eye disease (OPTIC). New England Journal of Medicine 2020.
• Kahaly GJ, Douglas RS, Holt RJ, et al. Teprotumumab for patients with chronic thyroid eye disease: a pooled data analysis, subgroup analyses, and off-treatment follow-up results from two randomised, double-masked, placebo-controlled, multicentre trials. Lancet Diabetes and Endocrinology 2021.
• Douglas RS, Wang Y, Yang H, et al. OPTIC-X open-label extension: teprotumumab for previously placebo-treated or recrudescent active thyroid eye disease.
• Ugradar S, Kang J, Kossler AL, et al. Teprotumumab for the treatment of chronic thyroid eye disease. Eye (London) 2022.
• Diniz SB, Tellez J, Williams RM, et al. Multi-centre real-world experience with teprotumumab. Ophthalmic Plastic and Reconstructive Surgery.
• Belinsky I, Creighton FX Jr, Mahoney N, et al. Audiometric outcomes in patients receiving teprotumumab. Ophthalmology / Ear, Nose and Throat literature.
• Sears CM, Azad AD, Amarikwa L, et al. Hearing loss after teprotumumab therapy for thyroid eye disease. JAMA Otolaryngology — Head and Neck Surgery.
• Perez-Moreiras JV, Gomez-Reino JJ, Maneiro JR, et al. Efficacy of tocilizumab in patients with moderate-to-severe corticosteroid-resistant Graves orbitopathy. American Journal of Ophthalmology 2018.
• Stan MN, Garrity JA, Carranza Leon BG, et al. Randomized controlled trial of rituximab for moderate to severe Graves ophthalmopathy. Journal of Clinical Endocrinology and Metabolism 2015.
• Salvi M, Vannucchi G, Currò N, et al. Efficacy of B-cell targeted therapy with rituximab in patients with active moderate to severe Graves orbitopathy. Journal of Clinical Endocrinology and Metabolism 2015.
• Bartalena L, Kahaly GJ, Baldeschi L, et al. The 2021 European Group on Graves orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves orbitopathy. European Journal of Endocrinology / Thyroid 2021.
• Marcocci C, Kahaly GJ, Krassas GE, et al. Selenium and the course of mild Graves orbitopathy. New England Journal of Medicine 2011.
• Kahaly GJ, Riedl M, König J, et al. Mycophenolate plus methylprednisolone versus methylprednisolone alone in active, moderate-to-severe Graves orbitopathy (MINGO). Lancet Diabetes and Endocrinology 2018.
• British Thyroid Association / Royal College of Physicians / Royal College of Ophthalmologists joint guidance on Graves orbitopathy.
• FDA Briefing Document, Tepezza (teprotumumab-trbw), January 2020.
• UK MHRA Specials guidance and Specials Import Licence framework.
• NICE Technology Appraisal scoping document for teprotumumab in thyroid eye disease (in scoping stage as of May 2026).
• American Academy of Ophthalmology Thyroid Eye Disease Preferred Practice Pattern.
• Care Quality Commission (CQC) inspection reports for major UK oculoplastic and infusion units.
• General Medical Council (GMC) Good Medical Practice and consent guidance.

This page is editorial and educational. It is not personalised medical advice. Tepezza suitability can only be confirmed by an in-person multi-disciplinary thyroid eye disease assessment including Hertel exophthalmometry, orthoptics, orbital imaging, audiometry and biochemistry.

Book your UK Tepezza / thyroid eye disease consultation

Speak directly to a UK GMC-registered consultant oculoplastic surgeon with thyroid eye disease subspecialty interest, working in a multi-disciplinary team with consultant endocrinology, ENT / audiology and orbital imaging. Same-week consultation slots are usually available. Hertel exophthalmometry, orthoptic assessment, clinical activity score, photographic documentation and a written treatment-options plan are included in the consultation. Confidential, no-obligation review of whether Tepezza, IV methylprednisolone, tocilizumab, orbital decompression or watchful waiting is right for your eye, with full discussion of MHRA / NICE status, ototoxicity and hyperglycaemia risk and the 24-week course commitment.

Related reading: Thyroid eye disease overview · Orbital decompression surgery · Private squint surgery London · Eyelid retraction surgery · Graves disease guide