Objectives To evaluate Tocilizumab (TCZ) in uveitis refractory to other biologic drugs.
Methods Multicenter study of 20 patients from 11 hospitals. All patients presented inadequate response to at least other biologic drug. The degree of ocular inflammation was evaluated according to SUN-2005. Macular thickness was defined by OCT. Comparisons were made between baseline and 1st week, 1st month, 6th month, 1st year. (Wilcoxon test)
Results We studied 20 patients/37 affected eyes (5 men/15 women); mean age, 27.4±16 years (range 8-67). The main underlying diseases were: Juvenile Idiopathic Arthritis (n=9), Behçet disease (n=3), spondyloarthritis (n=2), rheumatoid arthritis (n=1), and idiopathic uveitis (n=5). Besides oral steroids and before TCZ onset they had received: intraocular corticosteroids (n=13), methylprednisolone i.v. boluses (n=7), methotrexate (n=19), cyclosporine A (n=13), azathioprine (n=3), adalimumab (n=15), infliximab (n=9), abatacept (n=5) and golimumab (n=1). TCZ was started because inefficacy (n=20) and/or toxicity (n=3) to other biologics. TCZ was used as monotherapy (n=4) or in combination with methotrexate (n=11), leflunomide (n=2), cyclosporine A (n=2) and mycophenolate (n=1). There was a rapid (from 1st week) and maintained (1st year) improvement of visual acuity, anterior chamber inflammation, vitritis and OCT. The mean OCT in 5 cases (8 eyes) of macular thickness (OCT>250 μm) improved from 325±54.2 (baseline) to 264.3±22 μm (1st month) (p=0.03). After a mean follow-up of 13.7±10.2 months the more important side-effects observed were bullous impetigo (n=1) and mild thrombocytopenia (n=1).
Conclusions Tocilizumab seems effective and safe for patients with refractory uveitis to other biologic treatments.
Acknowledgements This study was supported by a grant from “Fondo de Investigaciones Sanitarias” PI12/00193 (Spain). This work was also partially supported by RETICS Programs, RD08/0075 (RIER) and RD12/0009/0013 from “Instituto de Salud Carlos III” (ISCIII) (Spain).
Disclosure of Interest : None declared