Abstract
Purpose :
There is limited data on the use of tocilizumab (TCZ) in the treatment of adult non-infectious uveitis. This study aims to evaluate the indications and efficacy of TCZ in the treatment of adult non-infectious uveitis at a single Australian centre.
Methods :
Retrospective chart review of patients who received TCZ at the Royal Victorian Eye & Ear Hospital. Collected data included demographics, diagnosis, grade of ocular inflammation as per SUN criteria, visual acuity (VA), presence of cystoid macular edema (CME), and medications.
Results :
TCZ was used in 5 patients (9 eyes). Two were female. Mean age at TCZ commencement was 32.8 years (range 22 – 44). Mean duration of follow-up after TCZ commencement was 30.1 months (range 4 – 68). Mean disease duration at TCZ commencement was 123 months (range 28 – 274). Four patients had bilateral uveitis. The ocular diagnosis was persistent panuveitis in 7 eyes (78%) and persistent anterior uveitis in 2 eyes (22%). Associated systemic diagnoses were juvenile idiopathic arthritis in 2 patients (40%), tattoo-associated uveitis in 1 patient (20%) and Behcet disease in 1 patient (20%). All patients had previously failed treatment with a tumour necrosis factor-alpha inhibitor (TNFI); 4 eyes (44%) failed adalimumab (ADA), 4 eyes failed both ADA and infliximab, and in 1 eye (11%) ADA was changed to TCZ due to adverse effects. VA improved from a mean logMAR VA at TCZ commencement of 0.55 (range -0.08 – 2.4), to 0.67 (range 0 – 2.4) at 6 months and 0.60 (range 0 – 2.4) at last review. The greatest effect was seen with the prednisolone dose which reduced from a mean of 17.6mg (range 4 – 50) at baseline, to 2.6mg (range 0 – 5) at 6 months and 3.1mg (range 0 – 5) at final follow up. All 8 eyes assessed had CME at baseline (1 eye was unable to be assessed due to ocular media opacity), by 6 months this had reduced to 4 of 8 eyes and by final follow up 3 of 8 eyes still had some CME. In these eyes, the mean central macular thickness was 347 microns (range 244 – 422) at baseline, 377 microns (range 235 – 648) at 6 months and reduced to 318 microns (range 241 – 454) at last review.
Conclusions :
Adult patients with persistent non-infectious uveitis who have failed TNFI treatment may benefit from switching biologic classes to TCZ, particularly if there is concurrent CME.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.