Objectives To assess the efficacy of Tocilizumab (TCZ) in refractory uveitis associated to juvenile idiopathic arthritis (JiA).
Methods Multicenter study of uveitis related to JiA and refractory to at least a) one standard synthetic immunosuppressive drug and, b) 1 anti-TNFα drug.
Results We studied 13 patients/24 eyes (2 men/11 women) with a mean age of 20.38±9 years (range 8-38). The most frequent ocular pattern was anterior uveitis (n=11), bilateral (n=11), and chronic (n=13).
Besides corticosteroids and before TCZ onset, they had received methotrexate (n=11), cyclosporine A (n=5), mycophenolate (n=1) and leflunomide (n=1). The first biologic treatment was: adalimumab (ADA) (n=6) (40 mg/sc/2 weeks), infliximab (IFX) (n=3) (5 mg/kg/i.v./every 6-8 weeks) and etanercept (ETN) (n=4). Before TCZ onset they had been switched to a second biologic drug (n=11) (most of them due to inefficacy), a third (n=5), a fourth (n=3) and even a fifth biologic therapy (n=1). The median of the duration of uveitis before the onset of TCZ was 122 months [IQR 42-178]. TCZ was used at a conventional dose (8 mg/kg/4 weeks) in most cases and combined in all cases (MTX=7, LFN=4, CsA=1, MMF=1). Improvement from baseline to 1 year was observed in: a) Visual acuity: from 0.46±0.35 to 0.52±0.37 (p=0.007); b) Anterior chamber cells from a median [IQR] of 1 [0.5-2] to 0 [0-0] (p=0.001), c) vitritis from 0 [0-1] to 0 [0-0] (p=0.06) and d) Macular thickness from a mean of 277±127 to 234±32 microns (p=0.04), and this allowed to taper corticosteroids from a mean of prednisone of 15±14 mg/day to 6±5 mg/day. After a mean follow-up of 15.2±8.3 months, ocular remission was achieved in 9 of 13 patients. The most severe adverse events of TCZ were severe thrombocytopenia (1), pneumonia (1), viral conjunctivitis and bullous impetigo (1).
Conclusions Tocilizumab seems to be effective in refractory uveitis related to JiA.
Disclosure of Interest None declared