Session Information
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose:
In uveitis, remission-inducing therapy with even more vigor than does rheumatology is mandatory. Since the eye is so much less forgiving of chronic inflammation than is the joint, with profound life-altering consequences. Cystoid macular edema (CME) is the leading cause of blindness in uveitis.
Our aim was to evaluate the rapid efficacy of Tocilizumab (TCZ) in refractory CME.
Methods: Multicentre study of 25 patients with CME due to non-infectious uveitis who had inadequate response or intolerance to traditional treatment with corticosteroids and at least one conventional immunosuppressive drug including in most cases biological therapy (n=22). CME was defined by (OCT >300 μm).
The outcome variables were the degree of inflammation of the anterior chamber and vitreous, visual acuity, macular thickness. The results are expressed as mean ±SD for normally distributed variables, or as median [interquartile range] when are not. Comparison of continuous variables was performed using the Wilcoxon test.
Results: 25 patients (17 women/8 men), mean age, 33.6±18.9 years were studied. The associated diseases were: juvenile idiopathic arthritis (9), Behçet’s disease (7), Birdshot retinochoroidopathy (4), idiopathic (4), sarcoidosis (1). The ocular pattern was: panuveitis (9), anterior uveitis (7), posterior uveitis (5) and intermediate uveitis (4). Most patients had bilateral involvement (24). Prior to biological therapies patients received: intraocular corticosteroids (22), iv. methylprednisolone (7), methotrexate (MTX) (19), cyclosporine A (CSA) (17), mycophenolate (4), azathioprine (2), leflunomide (2), cyclophosphamide (1), sulfasalazine (1), acetazolamide (1) and thalidomide (1). The biological used before the administration of TCZ were infliximab (8), adalimumab (19), etanercept (2), golimumab (2), rituximab (2), abatacept (3), anakinra (1) and daclizumab (1).
TCZ administration schedule was 8 mg/kg/4 weeks iv. (n=23), every 2 weeks (n=1) and subcutaneously 162 mg/2 week (n=1). TCZ was used in monotherapy (13) or combined with conventional immunosuppressive (12). Most of intraocular inflammation parameters showed a rapid improvement after TCZ onset (TABLE), with corticosteroid-sparing effect (15.9±13.6 to 8.5±5.17 mg; p=0.001). Remission was achieved in 8 patients and improvement in 17. After a month, no minor side effects were observed, so no patient had to stop treatment. No side effects were observed.
Conclusion: TCZ seems a rapid effective treatment in refractory uveitic CME.
TABLE
|
Baseline |
1st week |
2nd week |
1st month |
|
|
OCT (microns) mean ± SD |
415.7±177.15 |
413.3±162.9* |
388.06±158.1* |
330.8±104.2* |
|
Visual acuity mean ± SD |
0.39±0.31 |
0.4±0.31 |
0.45±0.3* |
0.51±0.3* |
|
Anterior chamber cells [median (IQR)] |
1 [0-1]* |
0.5 [0-1]* |
0 [0-1]* |
0 [0-0]* |
|
Vitritis [median (IQR)] |
1 [0-2] |
1 [0-1.5] |
0 [0-1]* |
0 [0-0.5]* |
*p <0.05 compared with basal data
To cite this abstract in AMA style:
Vegas-Revenga N, Calvo-Río V, Palmou-Fontana N, Mesquida M, Adan A, Hernández MV, Beltrán E, Valls Pascual E, Diaz-Valle D, Díaz-Cordovés G, Hernández- Grafella ML, Martínez- Costa L, Calvo I, Atanes A, Linares LF, Modesto C, Aurrecoechea E, Cordero-Coma M, Demetrio-Pablo R, Fernández-Díaz C, Domínguez-Casas LC, Martín-Varillas JL, Atienza-Mateo B, Hernández JL, González-Gay MA, Blanco R. Rapid Improvement with Tocilizumab in Refractory and Severe Uveitic Cystoid Macular Edema [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/rapid-improvement-with-tocilizumab-in-refractory-and-severe-uveitic-cystoid-macular-edema/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/rapid-improvement-with-tocilizumab-in-refractory-and-severe-uveitic-cystoid-macular-edema/