Abstract
Purpose :
The use of tocilizumab (TCZ), an interleukin-6 inhibitor, to treat non-infectious uveitis (NIU), one of the leading causes of preventable blindness worldwide, has generated considerable controversy. Therefore, we performed a systematic review and meta-analysis (MA) of existing literature to determine the efficacy and safety of TCZ in NIU treatment.
Methods :
A comprehensive online search was conducted using PubMed, Web of Science, Embase, Scopus databases and reference lists of pertinent studies for pre-post clinical trials published through October 2021. Overall, 2614 records were identified, of which 991 were duplicates. Subsequently, unrelated studies were excluded by title and abstract screening (n=1594) and full-text assessment (n=21). Ultimately, 5 of the 8 relevant studies included in the systematic review were eligible for inclusion in the MA. We recorded all reported adverse events (AE) and considered the mean difference in best-corrected visual acuity (BCVA) before and after TCZ treatment as the visual outcome. Weighted mean difference (WMD) with 95% confidence interval (CI) was employed as pooled estimation of intervention efficacy using random-effects MA. Heterogeneity was assessed using Cochran’s Q test and quantified with the I2 statistic. Sensitivity analysis was performed to evaluate the robustness of the MA findings using Stata version 14 software.
Results :
Pooled data of 46 patients (77 eyes) of the 5 included trials were meta-analyzed. In these studies, which had a mean follow-up of 14.58 months, 8 mg/kg TCZ was administered monthly to treat refractory uveitis-related macular edema, cystoid macular edema and juvenile idiopathic arthritis. TCZ AEs requiring dose lowering/discontinuation were reported in 2 cases (mild neutropenia and community-acquired pneumonia). Between-study heterogeneity was low (I2=18.7%,p=0.29) and mean LogMAR BCVA significantly improved after TCZ therapy (WMD=-0.26 (CI=-0.41to-0.10))(Fig1). Our MA supports a statistically significant improvement in BCVA, indicating a robustness of the finding.
Conclusions :
TCZ has statistically been demonstrated to be effective in NIU management with almost negligible AEs. This finding may provide clinicians with sufficient information to consider TCZ as a possible therapeutic option for eligible NIU patients.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.