Anti-IL-6 Receptor Tocilizumab in Refractory Graves' Orbitopathy: National Multicenter Observational Study of 48 Patients

被引：54

作者：

Sanchez-Bilbao, Lara ^{[1
]}

Martinez-Lopez, David ^{[1
]}

Revenga, Marcelino ^{[2
]}

Lopez-Vazquez, Angel ^{[2
]}

Valls-Pascual, Elia ^{[3
]}

Atienza-Mateo, Belen ^{[1
]}

Valls-Espinosa, Beatriz ^{[3
]}

Maiz-Alonso, Olga ^{[4
]}

Blanco, Ana ^{[4
]}

Torre-Salaberri, Ignacio ^{[5
]}

Rodriguez-Mendez, Veronica ^{[5
]}

Garcia-Aparicio, Angel ^{[6
]}

Veroz-Gonzalez, Raul ^{[7
]}

Jovani, Vega ^{[8
]}

Peiteado, Diana ^{[9
]}

Sanchez-Orgaz, Margarita ^{[9
]}

Tomero, Eva ^{[10
]}

De Miera, Francisco J. Toyos-Saenz ^{[11
]}

Pinillos, Valvanera ^{[12
]}

Aurrecoechea, Elena ^{[13
]}

Mora, Angel ^{[13
]}

Conesa, Arantxa ^{[14
]}

Fernandez-Prada, Manuel ^{[15
]}

Troyano, Juan A. ^{[16
]}

Calvo-Rio, Vanesa ^{[1
]}

Demetrio-Pablo, Rosalia ^{[1
]}

Gonzalez-Mazon, Inigo ^{[1
]}

Hernandez, Jose L. ^{[1
]}

Castaneda, Santos ^{[10
,17
]}

Gonzalez-Gay, Miguel A. ^{[1
]}

Blanco, Ricardo ^{[1
]}

机构：

[1] Univ Cantabria, Hosp Univ Marques de Valdecilla, IDIVAL, Rheumatol Ophthalmol & Internal Med, Santander 39008, Spain

[2] Hosp Univ Ramon y Cajal, Rheumatol & Ophthalmol, Madrid 28034, Spain

[3] Hosp Univ Doctor Peset, Rheumatol & Ophthalmol, Valencia 46017, Spain

[4] Hosp Univ Donosti, Rheumatol & Ophthalmol, San Sebastian 20014, Spain

[5] Hosp Univ Basurto, Rheumatol & Ophthalmol, Bilbao 48013, Spain

[6] Hosp Virgen de la Salud, Rheumatol, Toledo 45004, Spain

[7] Hosp Merida, Rheumatol, Merida 06800, Spain

[8] Hosp Gen Univ Alicante, Rheumatol, Alicante 03010, Spain

[9] Hosp Univ La Paz, Rheumatol & Ophthalmol, Madrid 28046, Spain

[10] Hosp La Princesa, IIS Princesa, Rheumatol, Madrid 28006, Spain

[11] Hosp Univ Virgen Macarena, Rheumatol, Seville 41009, Spain

[12] Hosp San Pedro, Rheumatol, Logrono 26006, Spain

[13] Hosp Sierrallana, Rheumatol & Ophthalmol, Torrelavega 39300, Spain

[14] Hosp Clin Univ Valencia, Rheumatol, Valencia 46018, Spain

[15] Hosp Univ Guadalajara, Rheumatol, Guadalajara 19002, Spain

[16] Hosp Univ Clin San Carlos, Ophthalmol, Madrid 28040, Spain

[17] Univ Autonoma Madrid UAM, EPID Future, Catedra UAM Roche, Madrid 28049, Spain

来源：

JOURNAL OF CLINICAL MEDICINE | 2020年 / 9卷 / 09期

关键词：

Graves’ disease; extrathyroidal manifestations; thyroid-associated ophthalmopathy; ophthalmopathy; corticoid-resistant; Tocilizumab; RHEUMATOID-ARTHRITIS; SERUM CONCENTRATIONS; UVEITIS; DISEASE; MANAGEMENT; THERAPY; ADALIMUMAB; RITUXIMAB; SCLERITIS;

D O I：

10.3390/jcm9092816

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Graves' orbitopathy (GO) is the most common extrathyroidal manifestation of Graves' disease (GD). Our aim was to assess the efficacy and safety of Tocilizumab (TCZ) in GO refractory to conventional therapy. This was an open-label multicenter study of glucocorticoid-resistant GO treated with TCZ. The main outcomes were the best-corrected visual acuity (BVCA), Clinical Activity Score (CAS) and intraocular pressure (IOP). These outcome variables were assessed at baseline, 1st, 3rd, 6th and 12th month after TCZ therapy onset. The severity of GO was assessed according to the European Group on Graves' Orbitopathy (EUGOGO). We studied 48 (38 women and 10 men) patients (95 eyes); mean age +/- standard deviation 51 +/- 11.8 years. Before TCZ and besides oral glucocorticoids, they had received IV methylprednisolone (n = 43), or selenium (n = 11). GO disease was moderate (n =29) or severe (n = 19) and dysthyroid optic neuropathy (DON) (n = 7). TCZ was used in monotherapy (n = 45) or combined (n = 3) at a dose of 8 mg/kg IV every four weeks (n = 43) or 162 mg/s.c. every week (n = 5). TCZ yielded a significant improvement in all of the main outcomes at the 1st month that was maintained at one year. Comparing the baseline with data at 1 year all of the variables improved; BCVA (0.78 +/- 0.25 vs. 0.9 +/- 0.16; p = 0.0001), CAS (4.64 +/- 1.5 vs. 1.05 +/- 1.27; p = 0.0001) and intraocular pressure (IOP) (19.05 +/- 4.1 vs. 16.73 +/- 3.4 mmHg; p = 0.007). After a mean follow-up of 16.1 +/- 2.1 months, low disease activity (CAS <= 3), was achieved in 88 eyes (92.6%) and TCZ was withdrawn in 29 cases due to low disease activity (n = 25) or inefficacy (n = 4). No serious adverse events were observed. In conclusion, TCZ is a useful and safe therapeutic option in refractory GO treatment.

引用

页码：1 / 15

页数：14

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