Abstract
Purpose:
To analyze the efficacy of tocilizumab, a monoclonal antibody against IL-6 receptor, in patients with chronic uveitic macular edema resistant to various immunomodulatory drugs.
Methods:
Retrospective analysis of an interventional case series. Patients received tocilizumab (RoActemra, Roche/Chugai Pharma) at a dose of 8 mg/kg bodyweight every 4 weeks intravenously. Central foveal thickness (CFT) was assessed by optical coherence tomography (OCT).
Results:
We included 5 patients (3 female, 2 male; mean age 42.6 years, 23-57 years) with 8 affected eyes (5 right eyes, 3 left eyes). ME was unilateral in 2 and bilateral in 3 patients. Localization/course of uveitis was chronic anterior (n=3), acute anterior (n=1), and intermediate (n=1). In addition, all patients suffered from systemic rheumatologic disease, either related or not related with uveitis (related: juvenile idiopathic arthritis, n=2; ankylosing spondylitis, n=1; not related: rheumatoid arthritis, n=2). Ineffective pre-treatment consisted of systemic prednisolone, at least one immunosuppressive drug, and at least one biologic drug in all patients. Mean follow-up was calculated for 16.2 months (4-35 months), mean duration of tocilizumab treatment for 14.6 months (4-35 months).<br /> Before start of tocilizumab, mean CFT was measured 738 µm (640-960 µm) in right and 576 µm (530-660 µm) in left eyes. At 3 months, a response of ME (at least 25% reduction in CFT) could be observed in both patients with unilateral ME, in both eyes in 1 patient and in 1 eye each in 2 patients with bilateral ME. In 2 eyes, ME did not respond to tocilizumab. During follow-up, complete absence of ME could be observed in both patients with unilateral ME, in both eyes in 1 patient and in 1 eye in another patient with bilateral ME. In 3 eyes, ME did not disappear. At the end of follow-up, mean CFT was 382 µm (150-820 µm) in right and 373 µm (190-630 µm) in left eyes. During follow-up, treatment with tocilizumab has to be discontinued in 1 patient with bilateral ME due to reactivation of the uveitis. Improvement of visual acuity of at least 0.3 logMAR in at least 1 eye could be observed in 3 patients (60%) during follow-up. Tocilizumab was well tolerated, no relevant side effects occurred.
Conclusions:
Treatment with tocilizumab can be considered in patients with chronic uveitic ME, even then if previous therapies with immunosuppressive and biologic drugs have failed.