Background Treatment recommended in severe and/or refractory uveitis of Behçet disease is anti-TNF-α therapy, usually infliximab (IFX) or adalimumab (ADA) (Levy-Clarke et al Ophthalmology 2014;121:785-796). However, in some cases these biologic agents are not effective, may be contraindicated or they are not well tolerated. IL-6 is a key cytokine in the pathogenesis of uveitis, including Behçet's syndrome.
Objectives Our aim was to evaluate the response to tocilizumab (TCZ) in uveitis associated with Behçet syndrome refractory to standard systemic treatment.
Methods Multicenter study on 7 patients with uveitis associated to Behçet disease. Patients had previously been treated with at least one conventional immunosuppressive drug and in most cases with anti-TNF-α agents. The main parameters assessed were the visual acuity (VA) and the degree of inflammation of the anterior and posterior chamber.
Results 4 men and 3 women were studied; mean age 39.1±15.4 years (range 22-67). Uveitis was bilateral (n=6) and unilateral (n=1) (Table). The pattern of ocular involvement was posterior uveitis (n=1), panuveitis (n=2), panuveitis + papilitis (n=1) and panuveitis + vasculitis (n=3). The clinical course was chronic (n=3) or recurrent (n=4).
Besides oral corticosteroids and before TCZ onset they had received: intraocular corticosteroids (n=7), i.v. methylprednisolone pulses (n=7), methotrexate (MTX) (n=7), (cyclosporin A) CsA (n=7), azathioprine (n=2), cyclophosphamide (n=2) daclizumab and mycophenolate (n=1), Adalimumab (n=5), infliximab (n=2) and golimumab (n=2). In all patients TCZ was prescribed at the standard dose (8 mg/kg/i.v. month). Treatment was administered as a monotherapy in 5 cases and combined with conventional immunosuppressive drugs in 2 cases (1 MTX, 1 CsA).
After a mean follow up of 5.36±5.1 months, from the onset of TCZ improvement was observed in the following items: a) median VA (0.2 [0.05-0.7] to 0.95 [0,4-1]; p<0.01); b) Median cells in the anterior chamber (1 [0-2] to 0 [0-0]; p=0.01); c) average vitritis (1.4±1.1 at 0±0; p<0.01); d) retinal vasculitis (n=8 eyes, 57.1%) that disappeared in all cases (p<0.01); e) OCT mean (μ) (from 335.7±82.3 to 246.4±32.6; p<0.01); f) 5 patients achieved remission, g) reduction in median dose of prednisone (30 [30-30] to 3.75 [0-7.5] mg/day; p=0.18). TCZ was withdrawn in 1 case due to an infusion reaction. No other side effects were observed.
Conclusions Treatment with TCZ seems to be effective in patients with refractory uveitis due to Behçet's disease.
Levy-Clarke et al Ophthalmology 2014;121:785-796
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