Background/Purpose:   Treatment recommended in severe and/or refractory uveitis of Behçet disease is anti-TNFα therapy, usually infliximab (IFX) or adalimumab (ADA) (Levy-Clarke et al Ophthalmology 2014). However, in some cases these biologic agents are not effective, may be contraindicated or they are not well tolerated. IL-6 is a key cytokine in the pathogenesis of uveitis. Our aim was to evaluate the response to tocilizumab (TCZ) in uveitis associated with refractory Behçet disease.

Methods:   Multicenter study of 11 patients with uveitis associated to Behçet disease. Patients had been treated with at least one conventional immunosuppressive drug and in most cases with anti-TNFα agents. The main parameters assessed were the visual acuity (VA) and the degree of intraocular inflammation. Cystoid Macular Edema (CME) was considered when OCT was greater than 300 μm.

Results:   We studied 11 patients (7 men/4 women); mean age 38.45±20.42 years. Uveitis was bilateral (n=9) and unilateral (2) (Table). The pattern of ocular involvement was panuveitis (n=8; 7 of them with retinal vasculitis, 6 with CME and 1 with papillitis), anterior uveitis (n=2, also with severe arthritis) and posterior uveitis (1 case; also with retinal vasculitis and CME). The clinical course was chronic (n=4) or recurrent (7). Besides oral corticosteroids and before TCZ they had received: intraocular corticosteroids (n=10), i.v. methylprednisolone (10), methotrexate (MTX) (9), (cyclosporin A) CsA (8), azathioprine (AZA) (3), cyclophosphamide (2), mycophenolate (1) and colchicine (1). All of them had received other biologic drugs: Adalimumab (n=8), Infliximab (4), Golimumab (3), etanercept (1), canakimumab (1) and daclizumab (1). In 10 patients TCZ was prescribed at 8 mg/kg/i.v. monthly and in 1 patient 162 mg/week/sc. TCZ was given in monotherapy (n=7) and combined in 4 cases (2 MTX, 1 CsA, 1 AZA). After a mean follow up of 9.5±8.05 months, improvement was observed in the following items: a) Mean VA (0.38±0.32 to 0.73±0.35; p=0.002); b) Median cells in the anterior chamber (1 [0-2.5] to 0 [0-0]; p=0.005; c) Median vitritis (1 [0-2] to 0 [0-0]; p=0.003); d) retinal vasculitis (n=10 eyes [45.45%] with resolution in all cases e) Mean OCT (μ) (from 359.46±115.96 to 257.66±71.7, p=0.0009; f) 8 patients achieved complete remission, g) reduction in median dose of prednisone (30 [20-30] to 0 [0-5]; p=0.1). TCZ was withdrawn in 2 cases, 1 due to an infusional reaction and 1 because of joint impairment.

Conclusion: Treatment with TCZ seems to be effective in patients with refractory uveitis due to Behçet’s disease. TABLE

Abbreviations: M: Male; F: Female; MTX: Methotrexate; CsA: cyclosporin A; AZA: azathioprine; CYM: cyclophosphamide; MMF: mycophenolate; ADA: Adalimumab; IFX: Infliximab; GLM: Golimumab, ETN: Etanercept

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/anti-il6-r-tocilizumab-in-refractory-uveitis-associated-with-behcets-disease-multicenter-study-of-11-patients/