EFFICACY AND SAFETY OF SUBCUTANEOUS TOCILIZUMAB FOR THYROID EYE DISEASE
- Javier Carbone, Spain
Abstract
Background and Aims
Intravenous tocilizumab is a therapy for moderate-severe active thyroid eye disease. We decribe efficacy and safety of subcutaneous tocilizumab in a patient with thyroid eye disease.
Methods
A 41-year-old white, non smoker, woman disclosed a 3-year history of hyperthyroidism. Partial response of thyroid function after methimazole and carbimazole was observed. Bilateral eye changes developed including upper eyelid inflammation, limitation of extraocular motility with eye proptosis, with important impact in her quality of life. The CAS was 4 on a scale of 7. Laboratory tests revealed free T4 2.4 pmol/L, low thyroid-stiumulating hormone (0.01 mIU/L), high anti-TSH-receptor antibodies (26.8 IU/L) and high serum IL-6 levels (14.84 ng/L, n.v. 0.00-6.40). IL2-R levels (556 U/mL) and regulatory CD4+CD25+CD127+ percentages (2.2%) were normal. After discussing with the patient therapeutical options we decided administer subcutaneous tocilizumab 162 mg each 8-9 days for a total of 16 doses (8 mg/kg/month). Baseline safety evaluation (complete blood count, immunoglobulin, complement, lymphocyte subset levels, liver function testing and tuberculosis screening) was normal. Pneumococcal vaccine was administered.
Results
After the first four doses of subcutaneous tocilizumab a significant improvement of thyroid eye disease with reduction of proptosis, eye symptoms and extraocular motility was observed. Infusions were were tolerated. No adverse reactions were observed. Laboratory tests revealed low thyroid-stimulating hormone (<0.01 mIU/L), a decrease of anti-TSH-receptor antibodies (from 26.8 to 9 IU/L and normal liver function tests.
Conclusions
Subcutaneous tocilizumab was efficacious and safe in a patient with thyroid eye disease. The potential role of this therapy should be evaluated in a clinical trial.