Tocilizumab for Uveitic Cystoid Macular Edema Refractory to Other Synthetic and Biological Immunosuppressive Drugs. Multicenter Study of 25 Patients

Natalia Palmou-Fontana¹, Vanesa Calvo-Río¹, Marina Mesquida², Alfredo Adan³, M. Victoria Hernández⁴, Emma Beltran⁵, Elia Valls⁶, David Diaz-Valle⁷, Gisela Díaz-Cordovés⁸, Marisa Hernández⁹, L. Martinez-Costa¹⁰, Inmaculada Calvo¹¹, Antonio Atanes-Sandoval¹², Luis Linares¹³, Consuelo Modesto¹⁴, Elena Aurrecochea¹⁵, Miguel Cordero-Coma¹⁶, Lucia C. Domínguez-Casas¹, Carlos Fernández-Díaz¹, Miguel Angel González-Gay¹ and Ricardo Blanco¹⁷, ¹Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Santander, Spain, ²Ophtalmology, Hospital Clinic, Barcelona, Spain, ³Ophthalmology, Hospital Clinic de Barcelona,, Barcelona, Spain, ⁴Rheumatology, Hospital Clinic. Barcelona. Spain, Barcelona, Spain, ⁵Rheumatology, Hospital General Universitario de Valencia, Valencia, Spain, ⁶Rheumatology, Hospital Dr. Peset., Valencia, Spain, ⁷Ophthalmology Department, Hospital Clínico San Carlos, Madrid, Spain, ⁸Rheumatology, Hospital Regional Universitario (Carlos Haya). Málaga. Spain., Málaga, Spain, ⁹Ophthalmology, Hospital General Universitario de Valencia. Spain, Valencia, Spain, ¹⁰Hospital Dr. Peset., Valencia, Spain, ¹¹Pediatric Rheumatology, Hospital Univ. La Fe, Valencia, Spain, ¹²Rheumatology, Complejo Hospitalario Universitario de La Coruña, La Coruña, Spain, ¹³Rheumatologist, hospital de la Arrixaca, MURCIA, Spain, ¹⁴Hospital Valle de Hebron, Barcelona, Spain, ¹⁵Rheumatology, Hospital de Sierrallana, Torrelavega, Spain, ¹⁶Departament of Ophthalmology, Hospital de León, León, Spain, ¹⁷Rheumatology Department. Hospital Universitario Marqués de Valdecilla, Santander, Spain

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: tocilizumab and uveitis

Session Information

Date: Monday, November 14, 2016

Title: Miscellaneous Rheumatic and Inflammatory Diseases - Poster II

Session Type: ACR Poster Session B

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

Background/Purpose: Our objective was to evaluate the efficacy and safety of Tocilizumab (TCZ) in a series of patients with refractory CME.

Methods: A Multicenter study of 25 patients with CME secondary 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. CME was defined by (OCT >300 μm). The outcome variables were the degree of inflammation of the anterior chamber and vitreous, visual acuity and macular thickness. Comparison of continuous variables was performed using theWilcoxon test.

Results: 25 patients (17 females/8 males) with CME were studied. Mean age of 33.6±18.9 years. The associated disease was: juvenile idiopathic arthritis (n=9), Behçet’s disease (n=7), Birdshot retinochoroidopathy (n=4), idiopathic (n=4), sarcoidosis (n=1). The ocular pattern was: panuveitis (n=9), anterior uveitis (n=7), posterior uveitis (n=5), intermediate uveitis (n=4). Most patients had bilateral involvement (n=24). Prior to TCZ patients received: intraocular corticosteroids (n=22), iv. methylprednisolone (n=7), methotrexate (MTX) (n=19), cyclosporine A (CSA) (n=17), mycophenolate (n=4), azathioprine (n=2), cyclophosphamide (n=1), sulfasalazine (n=1), daclizumab (n=1), acetazolamide (n=1), thalidomide (n=1), leflunomide (n=2), infliximab (n=8), adalimumab (n=19), etanercept (n=2), golimumab (n=2), rituximab (n=2), abatacept (n=3), anakinra (n=1). TCZ administration schedule was 8 mg/kg/4 weeks iv. in all patients except in one that was administered every 2 weeks. TCZ was used in monotherapy (n=11) or combined with conventional immunosuppressive: MTX (n=6), CsA (n=5) and leflunomide (n=1). A statistically significant reduction was observed in macular thickness from 415.68±177.15 to 259.1±499.5 microns; p=0.00009 during the first year of treatment with TCZ. Most of intraocular inflammation parameters showed also a rapid improvement after initiation of TCZ (TABLE). Visual acuity improved in a statistically significant way from 0.39±0.31 at baseline to 0.54±0.33 after one year of treatment (p =0.0002). After a mean follow up of 12.7±8.34 months only minor side effects were observed: nausea (n=1), viral conjunctivitis and bullous impetigo (n=1). Remission was achieved in 14 patients. The prednisone dose was reduced from 15.9±13.6 at baseline to 3.1±2.3 after a year of treatment; p=0.002.

Conclusion: Treatment with TCZ seems an effective and safe treatment in patients with uveitic CME refractory to other synthetic and biological immunosuppressive drugs TABLE

	Baseline	1st week	2nd week	1st month	3rd month	6th month	1st year
Visual acuity mean ± SD	0.39±0.31	0.4±0.31	0.45±0.31*	0.51±0.3*	0.57±0.32*	0.56±0.33*	0.54±0.34*
Anterior chamber cells [median (IQR)]	1 (0-1)	0.5(0-1)*	0 (0-1)*	0 (0-0)*	0 (0-0)*	0 (0-0)*	0 (0-0)*
Vitritis [median (IQR)]	1 (0-2)	1 (0-1.5)	0 (0-1)*	0 (0-0.5)*	0 (0-0.5)*	0 (0-0)*	0 (0-0)*
OCT (microns) mean ± SD	415.68±177.15	413.3±162.9*	388.06±158.1*	330.8±104.2*	290.26±76.53*	275.07±73.8*	259.1±49.51*

* p <0.05 compared with basal data

Disclosure: N. Palmou-Fontana, None; V. Calvo-Río, None; M. Mesquida, None; A. Adan, AbbVie, Santen and Allergan, 9; M. V. Hernández, None; E. Beltran, None; E. Valls, None; D. Diaz-Valle, None; G. Díaz-Cordovés, None; M. Hernández, None; L. Martinez-Costa, None; I. Calvo, Novartis Pharmaceutical Corporation, 2,AbbVie, Roche, Novartis, Sobi, 8; A. Atanes-Sandoval, None; L. Linares, None; C. Modesto, None; E. Aurrecochea, None; M. Cordero-Coma, None; L. C. Domínguez-Casas, None; C. Fernández-Díaz, None; M. A. González-Gay, None; R. Blanco, None.

To cite this abstract in AMA style:

Palmou-Fontana N, Calvo-Río V, Mesquida M, Adan A, Hernández MV, Beltran E, Valls E, Diaz-Valle D, Díaz-Cordovés G, Hernández M, Martinez-Costa L, Calvo I, Atanes-Sandoval A, Linares L, Modesto C, Aurrecochea E, Cordero-Coma M, Domínguez-Casas LC, Fernández-Díaz C, González-Gay MA, Blanco R. Tocilizumab for Uveitic Cystoid Macular Edema Refractory to Other Synthetic and Biological Immunosuppressive Drugs. Multicenter Study of 25 Patients [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/tocilizumab-for-uveitic-cystoid-macular-edema-refractory-to-other-synthetic-and-biological-immunosuppressive-drugs-multicenter-study-of-25-patients/. Accessed .

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