EVALUATION OF INTRAVENOUS TOCILIZUMAB FOR THE THERAPY OF MODERATE TO SEVERE GRAVES' OPHTHALMOPATHY
- Javier Carbone, Spain
Abstract
Background and Aims
Thyroid-associated ophthalmopathy is an extrathyroidal manifestation of Graves disease, occasionally severe and refractory to treatment. The complications of this disease have a high negative impact in the quality of life of the patients. A infiltrating cytokine in the orbital tissue is interleukin-6. We here report efficacy and safety of the use of intravenous tocilizumab in moderate to severe Graves' ophthalmopathy in a single center.
Methods
Prospective case report. Clinical and Immunological data of 5 cases. Patients with moderate to severe Graves' ophthalmopathy were subsequently included to receive a protocol of monthly intravenous tocilizumab at a dose of 8 mg/kg/dose (total 4 doses). All reported a past or present history of dysthyroidism. Safety evaluation before tocilizumab infusions was performed.
Results
The administration of interleukin-6-receptor monoclonal antibody treatment was associated with a significant improvement in CAS scores (ocular symptoms, proptosis), and functional prognosis in all patients. Improvement of myxedema was also observed in a patient with this extrathyroidal manifestation of Graves disease. Improvement in the European Group on GO-proposed composite ophthalmic score was also observed. Patients communicated better quality of life after therapy. Infusions were tolerated well. In one patient a reduction to 4mg/kg/dose was introduced due to increase of liver transaminase levels. No infectious complications were observed. A significant decrease of anti-TSH-receptor antibody titers was documented (13.26 vs 3.6 IU/L, 2-sided T-test p=0.019).
Conclusions
These data further support the efficacy and tolerability profile of intravenous tocilizumab in moderate to severe or corticosteroid-resistant Graves' ophthalmopathy.