Refractory and Severe Uveitic Cystoid Macular Edema Improves with Tocilizumab in Different Immune Mediated Diseases

Nuria Vegas-Revenga¹, Vanesa Calvo-Río¹, Marina Mesquida², Alfredo Adan², M. Victoria Hernández², Emma Beltrán³, Elia Valls Pascual⁴, David Diaz-Valle⁵, Gisela Díaz-Cordovés⁶, Marisa Hernandez Grafella⁷, Lucía Martínez-Costa⁸, Inmaculada Calvo⁹, Antonio Atanes¹⁰, Luis Francisco Linares¹¹, Consuelo Modesto¹², Elena Aurrecoechea¹³, Miguel Cordero-Coma¹⁴, Rosalía Demetrio-Pablo¹, Lucia C. Domínguez-Casas¹⁵, José Luis Hernández¹, Miguel Angel González-Gay¹ and Ricardo Blanco¹⁵, ¹Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, ²Hospital Clinic. Barcelona. Spain, Barcelona, Spain, ³Rheumatology, Hospital del Mar. Barcelona. Spain, Barcelona, Spain, ⁴Hospital Universitario de Valencia. Spain, Valencia, Spain, ⁵Hospital Clínico San Carlos. Madrid. Spain, Madrid, Spain, ⁶Rheumatology, Hospital Regional Universitario de Málaga. Spain, Málaga, Spain, ⁷Hospital Doctor Peset. Valencia. Spain, Valencia, Spain, ⁸Hospital Doctor Peset. Valencia. Spain, Valencia., Spain, ⁹Hospital Universitario La Fe, Valencia, Spain, ¹⁰Complejo Hospitalario Universitario A Coruña. Spain, A Coruna, Spain, ¹¹Rheumatology, Hospital Virgen de la Arrixaca. Murcia. Spain, Murcia, Spain, ¹²Hospital Universitari Vall d'Hebron. Barcelona. Spain, Barcenola, Spain, ¹³Rheumatology, Hospital de Sierrallana. Torrelavega. Spain, Torrelavega, Spain, ¹⁴Ophthalmology, Hospital de León. Spain, León, Spain, ¹⁵Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: tocilizumab and uveitis

Session Information

Date: Tuesday, October 23, 2018

Title: Miscellaneous Rheumatic and Inflammatory Diseases Poster III: Sarcoid, Inflammatory Eye Disease, and Autoinflammatory Disease

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Cystoid macular edema (CME) represents the leading cause of blindness in uveitis of different immune mediated diseases (IMD). Our aim was to evaluate the efficacy of Tocilizumab (TCZ) in different IMD with refractory CME to other immunosuppressive drug.

Methods: Multicentre study of 24 patients with CME due to uveitis of different IMD refractory to traditional treatment with systemic corticosteroids and at least one conventional immunosuppressive drug including in most cases biological therapy (n=21). CME was defined by (OCT >300 μm). We studied CME with TCZ in 4 different IMD: juvenile idiopathic arthritis (JiA), Behçet’s disease (BD), Birdshot retinochoroidopathy (BR) and idiopathic.

The main outcome was the improvement of macular thickness. Other variables assessed were inflammation of the anterior chamber and vitreous and best corrected visual acuity (BCVA).

Results: We studied 16 ♀/8 ♂, mean age 35.2±19.3 years. The associated diseases were: JiA (n=9), BD (n=7), BR (n=4) and idiopathic (n=4). The ocular patterns were: panuveitis (9), anterior uveitis (6), posterior uveitis (5) and intermediate uveitis (4). Most patients had bilateral involvement (22). The biological therapy used before the administration of TCZ were infliximab (8), adalimumab (18), 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) or every 2 weeks (n=1). TCZ was used in monotherapy (12) or combined with conventional immunosuppressive drugs (12). OCT values improved considerably in 12 months: in JiA from 340.6 ± 134.1 μm to 252.5 ± 30 μm, in BD from 375.1 ± 117 μm to 235 ± 7.1 μm, in BR from 550.7 ± 214.4 μm to 295.5 ± 43.2 μm and in idiopathic from 515 ± 219.6 μm to 208.3 ± 46.7 μm (FIGURE). Inflammation in anterior chamber and vitritis and BCVA also improved in the 4 subtypes. No major side effects were observed, so no patient had to stop treatment.

Conclusion: TCZ seems a rapid effective treatment in severe and refractory uveitic CME, regardless of the underlying IMD.

FIGURE

Disclosure: N. Vegas-Revenga, None; V. Calvo-Río, None; M. Mesquida, None; A. Adan, None; M. V. Hernández, None; E. Beltrán, None; E. Valls Pascual, None; D. Diaz-Valle, None; G. Díaz-Cordovés, None; M. Hernandez Grafella, None; L. Martínez-Costa, None; I. Calvo, None; A. Atanes, None; L. F. Linares, None; C. Modesto, None; E. Aurrecoechea, None; M. Cordero-Coma, None; R. Demetrio-Pablo, None; L. C. Domínguez-Casas, None; J. L. Hernández, None; M. A. González-Gay, None; R. Blanco, None.

To cite this abstract in AMA style:

Vegas-Revenga N, Calvo-Río V, Mesquida M, Adan A, Hernández MV, Beltrán E, Valls Pascual E, Diaz-Valle D, Díaz-Cordovés G, Hernandez Grafella M, Martínez-Costa L, Calvo I, Atanes A, Linares LF, Modesto C, Aurrecoechea E, Cordero-Coma M, Demetrio-Pablo R, Domínguez-Casas LC, Hernández JL, González-Gay MA, Blanco R. Refractory and Severe Uveitic Cystoid Macular Edema Improves with Tocilizumab in Different Immune Mediated Diseases [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/refractory-and-severe-uveitic-cystoid-macular-edema-improves-with-tocilizumab-in-different-immune-mediated-diseases/. Accessed .

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