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Vimal Sarup, Anum Butt, Kanza Aziz, C. Stephen Foster; Efficacy of Tocilizumab, an IL-6 receptor inhibitor in ocular inflammatory disorders: a pilot study. Invest. Ophthalmol. Vis. Sci. 2013;54(15):112.
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Tocilizumab is a Humanized Anti Interleukin 6 Monoclonal antibody evaluated and used for its beneficial effects on systemic autoimmune inflammatory disease but not for non infectious ocular inflammation. In this pilot study, tocilizumab was evaluated to study its effect on ocular Inflammation refractory to the extended spectrum of conventional and immunomodulatory medications.
Eleven patients with non resolving non infectious ocular inflammation involving anterior segment, posterior segment or both, who had not responded completely to other medications were evaluated. Tocilizumab was given via intravenous infusions to augment the existing medications on a set schedule and dosage. Detailed ocular examination with slit lamp and dilated fundus examination was done. Ocular inflammation was graded according to SUN criteria. A full spectrum of diagnostic testing included fluorescein angiography, OCT, and Ultrasound B scan as necessary. Age, sex, race, ocular and systemic side effects were noted in addition. Systemic side effects were evaluated by blood tests and physical examinations by general physicians or rheumatologists.
Nine patients were Caucasians, eight were females, average age was 43.8 yrs, and they had failed four systemic immunomodulatory medications on average. There were 6 cases of Uveitis, 3 of Scleritis, 1 orbital inflammatory disease, and 1 peripheral ulcerative keratitis. Eight patients responded favorably by reduction in ocular inflammation including four patients who went into remission. Two patients had infusion reactions with initiation of treatment and the drug had to be discontinued. Two others had systemic side effects but the ocular inflammation had shown improvement.
These data indicate that tocilizumab improves anterior and posterior segment ocular inflammation of varied non infectious etiologies. It has the potential to not only stabilize but induce remission of inflammation, even though other systemic medications failed or induced systemic side effects. Further double blind prospective trials are necessary to evaluate its role in ocular inflammation.
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