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Christoph M E Deuter, Manfred Zierhut, Annette Igney-Oertel, Theodoros Xenitidis, Alexandra Feidt, Deshka Doycheva; Tocilizumab in uveitic macular edema refractory to previous immunomodulatory treatment. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3113.
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© ARVO (1962-2015); The Authors (2016-present)
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.
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).
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.
Treatment with tocilizumab can be considered in patients with chronic uveitic ME, even then if previous therapies with immunosuppressive and biologic drugs have failed.
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