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Marina Mesquida, Victor Llorens, Blanca Molins, Maite Sainz de la Maza, Alfredo Adan Civera; Long-term effects of tocilizumab therapy for uveitic macular edema. Invest. Ophthalmol. Vis. Sci. 2014;55(13):107.
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To report the long-term efficacy and safety of the IL-6R antagonist tocilizumab (TCZ) for uveitic macular edema (UME) refractory to immunomodulatory therapy.
Five refractory patients with UME who received TCZ infusions between January 2012 and October 2013 were identified by retrospective chart review. All patients received 8 mg/kg TCZ at 4-weeks intervals. Main outcome measures: Central foveal thickness (CFT) measured by optical coherence tomography, degree of anterior and posterior chamber inflammation (Standardization of Uveitis Nomenclature Working Group criteria), and visual acuity (logarithm of the minimum angle of resolution [log-MAR]) were recorded during TCZ therapy at months 1, 3, 6, and 12.
Eight eyes from 5 patients (all females) were included. Mean age was 51.4 years. Mean follow-up was 15 months (range, 12-18). Before TCZ, all patients failed conventional IS therapy and had received at least 1 another biologic agent. Uveitis diagnoses were: Birdshot chorioretinopathy (n=3), juvenile idiopathic arthritis-associated-uveitis (n=1), and idiopathic panuveitis (n=1). Mean baseline CFT (95% confidence interval) was 602 ± 236 μm in baseline, 386 ± 113 μm at month 1 (p= 0.006), 323 ± 103 μm at month 3 (p= 0.026), 294.5 ± 94.5 μm at month 6 (p= 0.014), and 266 ± 74.4 at month 12 of follow-up (p=0.006). Median log-MAR best-corrected visual acuity (BCVA) improved from 0.66 ± 0.57 in baseline to 0.47 ± 0.62 at month 12 (p = 0.018). TCZ therapy was withdrawn in 2 patients due to sustained remission at 12 months. In one patient UME relapsed and TCZ had to be restarted, while the other patient remained UME-free until last follow-up. TCZ was generally well tolerated and no serious adverse events were reported.
These data suggest that TCZ is effective for treating UME in otherwise refractory cases.
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