Can Tepezza Cause or Worsen Inflammatory Bowel Disease?

Tepezza (teprotumumab) has been associated with stomach and intestinal issues, including potential flare-ups of pre-existing Crohn’s disease or ulcerative colitis ^[1][2]. While many patients experience mild gastrointestinal side effects, there are reports of individuals developing serious inflammatory bowel disease (IBD) complications, and in some reported cases, entirely new onset of IBD ^[3][4].

Because you already have Crohn’s disease or ulcerative colitis, it is important to thoroughly discuss your digestive health history with your doctors before considering this medication ^[5]. The decision to proceed should be made jointly by your eye-care team and your gastroenterologist.

What the Evidence Says

The exact risk of an IBD flare while taking Tepezza is not fully known. The available evidence presents a mixed picture:

• General Side Effects: In clinical trials, general gastrointestinal issues were common, with about 17% of patients reporting nausea and 13% reporting diarrhea ^[6][7]. However, these trial populations did not primarily consist of patients with pre-existing IBD, and ordinary treatment-related diarrhea is not the same as an IBD flare ^[6].
• Safety Reports: An analysis of the FDA’s adverse event database found a higher rate of IBD-related reports among Tepezza users ^[1]. Such spontaneous safety reports can identify a possible safety signal, but they cannot prove that the drug caused the event or establish a true incidence rate ^[1]. In contrast, a population study comparing Tepezza to steroid treatments found no definitive difference in IBD risk ^[8].
• Case Reports: There are published case reports of patients developing severe ulcerative colitis after receiving several Tepezza infusions ^[3][4]. In these specific cases, stopping the drug did not result in immediate symptom relief, and patients required biologic medicines to manage the condition ^[3][4]. The timing of symptom onset varied across these reports, meaning there is no predictable “safe window” during your treatment course ^[3][4].

Is Pre-Existing IBD a Contraindication?

You may encounter medical reviews that refer to pre-existing IBD as a contraindication (a strict rule not to use a medication) for Tepezza ^[6]. However, expert consensus guidelines from specialists state that having IBD does not automatically mean you cannot take the drug ^[5].

Instead, the presence of Crohn’s disease or ulcerative colitis requires an individualized risk-benefit discussion ^[5]. Your doctors will weigh the severity and threat of your thyroid eye disease against the potential risks to your digestive system. If you proceed with treatment, the expert consensus recommends “stringent monitoring” of your gastrointestinal health ^[5].

Recognizing Symptoms and When to Seek Help

It can be difficult to tell the difference between a common side effect, a stomach infection, or an IBD flare. Symptoms can overlap, and an IBD flare may start mildly. Do not try to diagnose the cause of your symptoms at home, and do not stop taking your IBD medications or Tepezza infusions without consulting your care team ^[5].

If you develop new or worsening digestive symptoms, do not wait for your next infusion to report them ^[5].

When to contact your care team the same day:
Call your doctor promptly if you notice a change from your baseline, such as:

• New or worsening bloody diarrhea or mucus in your stool ^[3]
• New or worsening fecal urgency (the sudden, immediate need to pass a bowel movement) ^[3]
• Persistent diarrhea that is different from your normal routine ^[3][4]
• New abdominal cramping or pain

When to seek emergency medical care:
Go to the nearest emergency room if you experience:

• Heavy or persistent rectal bleeding
• Black, tarry stools accompanied by weakness or fainting
• Severe or rapidly worsening abdominal pain or swelling
• High fever or repeated vomiting
• Inability to keep fluids down (signs of severe dehydration)