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Marina Mesquida, Blanca Molins, Victor Llorens, Anna Sala-Puigdollers, Jessica Matas, Javier Zarranz-Ventura, Maite Sainz De La Maza, Alfredo Adan Civera, Uveitis Unit, Ophthalmology Department, Hospital Clinic of Barcelona; Long-term treatment with Tocilizumab for non-infectious uveitis. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3112.
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To report the long-term efficacy and safety of the IL-6 receptor antagonist tocilizumab (TCZ) for refractory uveitis and its related macular edema (ME).
Data were obtained by standardized chart review. Main outcome measures: central foveal thickness (CFT) measured by optical coherence tomography, anterior chamber cell grade, vitreous haze, and best-corrected visual acuity (logarithm of the minimum angle of resolution [log-MAR]) were recorded during TCZ therapy at months 1, 3, 6, 12, 18, and 24.
Seventeen eyes from 12 patients (10 females) were included. Mean age was 38.6 years. Mean duration of ME was 12.3 years. Mean follow-up with TCZ therapy was 21.8 months (range, 6-24). Before TCZ, all patients failed conventional immunosuppressive therapy and one or more biologic agents. Uveitis diagnoses were: juvenile idiopathic arthritis-associated-uveitis (n=5), birdshot chorioretinopathy (n=3), idiopathic panuveitis (n=2), sympathetic ophthalmia (n=1), and ankylosing spondylitis (n=1). Mean CFT (95% confidence interval) was 530 ± 194 μm in baseline, 370 ± 95 μm at month 1 (p= 0.004), 303 ±78 μm at month 3 (p=0.0009), 275 ± 72 μm at month 6 (p= 0.000025), 288 ± 107 at month 12 (p=0.002), and 297 ± 99 at month 24 (p=0.015) of follow-up. TCZ’s major efficacy on CFT can be observed at months 6 to 9 (nadir), reaching a plateau from month 12 of follow-up onwards.<br /> Mean log-MAR best-corrected visual acuity improved from 0.72 ± 0.65 in baseline to 0.54 ± 0.62 at month 6 (p = 0.0019), 0.54 ± 0.65 at month 12 (p = 0.007), and 0.6 ± 0.76 at month 24 (p = 0.02). TCZ therapy was withdrawn in 2 patients due to sustained remission at month 12. In both patients, ME relapsed 3 months after TCZ withdrawal. Reinitiation of TCZ therapy led to good uveitis control and ME resolution. With regards to safety, one patient developed mild neutropenia and another patient showed increased liver enzymes, none of which required TCZ withdrawal.
TCZ may be safe and effective for uveitis and its associated ME in otherwise refractory cases.
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