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Jordan Ueberroth, Arash Maleki, Peter Y Chang, Stephen D Anesi, C Stephen Foster; Efficacy of tocilizumab for the treatment of refractory noninfectious retinal vasculitis: a report of preliminary, 3-month outcomes. Invest. Ophthalmol. Vis. Sci. 2020;61(7):5353.
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Retinal vasculitis is a sight-threatening and often refractory inflammatory process of the retinal vasculature. Tocilizumab is a humanized monoclonal antibody that blocks the interleukin-6 receptor and has demonstrated efficacy in treating systemic vasculitic disorders. This study seeks to determine whether tocilizumab is an effective agent for treating refractory noninfectious retinal vasculitis and report 3 month follow-up data.
We performed an observational, retrospective, standardized chart review of all patients who were treated with monthly intravenous tocilizumab 8mg/kg infusions for noninfectious retinal vasculitis at single tertiary care facility. To meet inclusion criteria, patients had to fail at least 1 anti-metabolic agent and at least 1 biologic response modifier prior to treatment with tocilizumab. Patients treated concomitantly with oral corticosteroids were exluded from this study. Wide-field fluorescein angiograms obtained at baseline, 1 and 3 months after initiation of tocilizumab therapy were analyzed by a masked reviewer. The vasculitic activity on each angiogram was quantified according to the system developed by The Angiography Scoring for Uveitis Working Group and assigned a score between 0 and 40. The primary outcome measure was change in angiographic vasculitis score at 1 and 3 months after initiation of tocilizumab therapy. Statistical significance was determined using the Wilcoxon signed-rank test with Bonferroni correction.
A total of 24 eyes from 15 patients were analyzed. Mean age was 32 years with 11 female patients. Retinal vasculitis was associated with panuveitis (n=4), juvenile idiopathic arthritis (n=5) and idiopathic (n=6). On average patients failed 3.63 different immunomodulatory therapies. Angiogram scores were 8.75 ± 4.32 at baseline, 7.29 ± 3.77 at month 1, and 6.21 ± 3.43 at month 3. The vasculitis score improved by 1.46 points (p=0.015) from baseline to month 1, by 1.08 points (p=0.039) from month 1 to month 3, and by 2.54 points (p=0.003) from baseline to month 3.
This study demonstrates that tocilizumab may effectively reduce angiographic vasculitic activity among patients with refractory noninfectious retinal vasculitis within three months of initiating therapy. Additional studies are needed to determine long-term efficacy and clinical significance.
This is a 2020 ARVO Annual Meeting abstract.
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