Efficacy and safety of tocilizumab in the management of non-infectious retinal vasculitis

Abstract

Purpose : To determine the efficacy and safety of intravenous (IV) tocilizumab (TCZ) in patients with non-infectious retinal vasculitis who failed conventional immunomodulatory therapy (IMT) and anti-tumor necrosis factor-alpha (anti-TNFa) therapy.

Methods : Medical records of seven patients with retinal vasculitis treated with monthly or biweekly IV TCZ (8 mg/kg) at a university uveitis clinic were reviewed to include demographics, ocular findings, previous treatment modalities, optical coherence tomography, and wide-angle fluorescein angiography (WAFA). Patients included in this index study were refractory to at least one IMT and anti-TNFa agent. Outcome measures were changes in visual acuity (VA), central macular thickness (CMT), and WAFA score. The Angiographic Scoring for the Uveitis Working Group (ASUWOG) system was utilized for FA scoring.

Results : Ten eyes of seven patients received TCZ therapy for a diagnosis of retinal vasculitis. The median age of patients was 14 years (range, 7-24). 57% of subjects were female. Clinical diagnosis of patients was chronic juvenile idiopathic uveitis (n:4), idiopathic retinal vasculitis (n:2), and HLA-B27-associated uveitis (n:1). Previous treatments of patients include methotrexate (n: 6 ), adalimumab (n:4 ), infliximab (n:6), and golimumab (n:2). The mean duration of TCZ therapy, up to most recent visit, was 7.1±3.5 months. The mean VA improvement was +4.0±5.6 ETDRS letters. None of the patients showed worsening in the VA. The mean CMT reduced from 373 ± 100mm to 298 ± 40mm (p>0.05), and the mean FA score reduced from 12.7 ± 4.8 to 4.2 ± 3.7 (p<0.001). Repeated infusions of TCZ were well tolerated by all subjects. One patient developed mildly elevated liver transaminases, which subsequently normalized. Figure demonstrates WAFA and OCT findings in a representative patient.

Conclusions : IV TCZ is a potentially effective and safe therapeutic option for the management of retinal vasculitis refractory to conventional IMT and anti-TNFa therapy.

This is a 2021 ARVO Annual Meeting abstract.

 

Figure. Representative images from a study patient at A: Baseline WAFA, showing diffuse areas of capillary leakage and an area of disc hyperfluorescence (A) and after tocilizumab treatment, showing a significant improvement in capillary leakage and disc hyperfluorescence (B). Baseline OCT showing CME (C) and after tocilizumab treatment, OCT showing complete resolution of CME (D).