For Active & Chronic Thyroid Eye Disease
Lumvoa (veligrotug-vvze) is the second FDA-approved medical therapy targeting the underlying biology of Thyroid Eye Disease, and the first with pivotal data in both the active and chronic phases. In its phase-3 trials it produced a ≥2 mm reduction in proptosis (bulging eyes) in 70% of patients with active disease — over a shorter 5-infusion course than the first-generation option — while significantly improving double vision and inflammation.
Lumvoa (generic name: veligrotug) is a fully antagonist monoclonal antibody to the IGF-1 receptor (IGF-1R), developed by Viridian Therapeutics and approved by the FDA in June 2026 for the treatment of Thyroid Eye Disease (TED), also called Graves' ophthalmopathy. Like teprotumumab (Tepezza), it is given as an intravenous (IV) infusion in an outpatient infusion center or physician's office, and it is approved for thyroid eye disease regardless of disease activity or duration.
What sets Lumvoa apart is that its pivotal program studied both recent-onset (active) TED and long-standing (chronic) TED — the latter a group with historically few non-surgical options. It reaches its treatment course in about 12 weeks (5 infusions), compared with the 24-week, 8-infusion teprotumumab schedule.
ASOPRS fellowship-trained oculoplastic surgeons are uniquely qualified to manage Thyroid Eye Disease across its full natural history — from monitoring the active inflammatory phase and administering IGF-1R therapy, through surgical rehabilitation when the disease stabilizes.
The hallmark of TED is activation of orbital fibroblasts — connective tissue cells within the orbit — by two key immune receptors: the thyroid-stimulating hormone receptor (TSHR) and the insulin-like growth factor-1 receptor (IGF-1R). When autoantibodies bind these receptors, fibroblasts proliferate, produce excess hyaluronic acid, and differentiate into fat cells, expanding orbital volume. The result is proptosis, lid retraction, double vision, and orbital pain.
Veligrotug is a full antagonist monoclonal antibody that binds and blocks the IGF-1R receptor, interrupting the signal cascade that drives fibroblast activation. By silencing this pathway, the drug:
Veligrotug and teprotumumab share the same molecular target (IGF-1R), so they act on the same disease mechanism — distinct from corticosteroids, which broadly suppress inflammation rather than interrupting the fibroblast-activation pathway.
Lumvoa was approved on the basis of two randomized, double-masked, placebo-controlled phase-3 trials: THRIVE in active TED and THRIVE-2 in chronic TED. Both dosed 5 intravenous infusions of 10 mg/kg given 3 weeks apart over about 12 weeks, with primary endpoints assessed at week 15.
| Outcome (week 15) | Lumvoa | Placebo |
|---|---|---|
| Proptosis response (≥2 mm reduction) | 70% | 5% |
| Mean proptosis reduction | 2.9 mm | 0.5 mm |
| Mean Clinical Activity Score decrease | −3.4 | −1.7 |
| Complete diplopia resolution | 54% | 12% |
| Outcome (week 15) | Lumvoa | Placebo |
|---|---|---|
| Proptosis response (≥2 mm reduction) | 56% |
Lumvoa (veligrotug) and Tepezza (teprotumumab) are both IGF-1R–blocking antibodies given by IV infusion, and both are approved for TED regardless of activity or duration. They have not been compared head-to-head in a single trial, so the figures below come from separate studies (OPTIC for Tepezza; THRIVE/THRIVE-2 for Lumvoa) and cannot be directly equated — but they outline the practical differences.
| Feature | Lumvoa (veligrotug) | Tepezza (teprotumumab) |
|---|---|---|
| FDA approval | June 2026 | January 2020 |
| Target | IGF-1R | IGF-1R |
| Infusion course | 5 infusions / ~12 weeks | 8 infusions / 24 weeks |
| Dose | 10 mg/kg every 3 weeks | 10 mg/kg, then 20 mg/kg every 3 weeks |
| Proptosis response (active) | 70% (THRIVE, wk 15) | 83% (OPTIC, wk 24) |
| Mean proptosis reduction (active) | 2.9 mm | 2.82 mm |
Because Lumvoa has pivotal data in both active and chronic disease, candidacy is broader than for therapies studied only in recent-onset TED. Key considerations:
THRIVE studied active disease (onset ≤15 months) and THRIVE-2 studied chronic disease (onset >15 months). Candidacy is individualized and does not require a minimum activity score.
Proptosis of at least 3 mm above normal, or diplopia that affects daily function — the entry threshold used in the trials.
Thyroid hormone levels should be stabilized with endocrinology management before or alongside treatment.
Because IGF-1R antagonists can affect hearing and blood glucose, baseline audiology and glucose assessment help identify patients who need closer monitoring.
Lumvoa is given as 5 intravenous infusions of 10 mg/kg given 3 weeks apart over about 12 weeks:
Eye measurements (Hertel exophthalmometry), Clinical Activity Score, blood glucose, and a hearing assessment are recorded before the first infusion.
10 mg/kg IV every 3 weeks. Eye measurements and symptom checks at each visit track proptosis and diplopia response; glucose and hearing are monitored through the course.
Primary response is assessed after the fifth infusion. Stable disease is then monitored; residual structural changes may still be addressed with surgical rehabilitation.
In THRIVE, 94% of patients completed the full course and most adverse events were mild. As an IGF-1R antagonist, Lumvoa shares the class effects seen with teprotumumab — hearing changes and elevated blood glucose are the most important to monitor.
Otologic symptoms are a known IGF-1R class effect. In THRIVE, hearing-impairment events occurred in about 16% of Lumvoa patients versus 11% on placebo. Baseline and follow-up audiology is advised, especially for patients with pre-existing hearing problems, and any new tinnitus or hearing change should be reported promptly.
IGF-1R blockade can raise blood glucose. Patients with diabetes or pre-diabetes need closer monitoring, and fasting glucose should be checked during the treatment course.
Overall adverse events were reported in 88% of Lumvoa patients versus 63% on placebo, most of them mild. Infusion reactions can usually be managed by adjusting the infusion rate.
This summary reflects pivotal trial data (THRIVE phase 3 (active TED), topline week-15 results, Endocrine Practice 2025. THRIVE-2 phase 3 (chronic TED), topline week-15 results, Endocrine Practice 2025.) and is not a substitute for the full FDA prescribing information or a discussion with your physician.
TED is a complex, multi-stage disease that requires monitoring and management across its entire natural history — from the active inflammatory phase treated with IGF-1R therapy, through the stable phase where surgical rehabilitation is performed. An ASOPRS fellowship-trained oculoplastic surgeon is uniquely positioned to provide this continuity:
ASOPRS fellowship-trained surgeons measure proptosis, grade CAS, and interpret orbital imaging to track disease response over time.
They can weigh Lumvoa, Tepezza, and surgery together — matching the right option to disease phase, prior treatment, and each patient's risk profile.
When medical therapy plateaus — or when disease is inactive — oculoplastic surgeons perform orbital decompression, strabismus surgery, and eyelid recession.
TED is driven by underlying thyroid autoimmunity. Oculoplastic surgeons coordinate care with your endocrinologist and assist with prior authorization for infusion therapy.
Schedule an evaluation to find out whether Lumvoa, Tepezza, or surgical rehabilitation is the right next step for your thyroid eye disease.
| 8% |
| Mean proptosis reduction | 2.34 mm | 0.46 mm |
| Complete diplopia resolution | 32% | — |
Why chronic-disease data matters: most earlier TED therapy was studied only in recent-onset (active) disease. THRIVE-2 enrolled patients with long-standing TED (symptom onset beyond 15 months) and still showed a meaningful proptosis response, expanding the range of patients who may benefit from medical therapy before considering surgery.
| Chronic-disease pivotal data |
| Yes (THRIVE-2) |
| Not in the pivotal program |
| Otologic (hearing) events | ~16% in trial | ~10% in trial (higher on formal testing) |
Important: cross-trial percentages are not a head-to-head result — trial populations, endpoints, and timepoints differ (week 15 vs week 24). Both drugs share the same IGF-1R class effects, including a risk of hearing changes and elevated blood glucose. The right choice depends on disease phase, prior treatment, hearing and metabolic risk, and insurance coverage — a decision to make with an oculoplastic surgeon.
