Anti-IL-6 Receptor Tocilizumab in Refractory Graves’ Orbitopathy: National Multicenter Observational Study of 48 Patients
| Autor: | Marcelino Revenga, Valvanera Pinillos, Ángel García-Aparicio, Margarita Sánchez-Orgaz, Vanesa Calvo-Río, L. Sanchez-Bilbao, Belén Atienza-Mateo, Santos Castañeda, Ricardo Blanco, Elia Valls-Pascual, Beatriz Valls-Espinosa, Ana Blanco, Ángel Mora, José L. Hernández, Verónica Rodriguez-Mendez, Eva Tomero, D. Martínez-López, Diana Peiteado, Vega Jovaní, I. González-Mazón, O. Maiz-Alonso, M. Fernandez-Prada, Arantxa Conesa, Raúl Veroz-González, Juan A. Troyano, Miguel A. González-Gay, Elena Aurrecoechea, R. Demetrio-Pablo, I. Torre-Salaberri, Ángel López-Vázquez, Francisco J. Toyos-Sáenz de Miera |
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| Přispěvatelé: | UAM. Departamento de Medicina, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-IP), Universidad de Cantabria |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Intraocular pressure Visual acuity extrathyroidal manifestations Medicina Graves' disease lcsh:Medicine Gastroenterology Article Graves' ophthalmopathy 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Tocilizumab Refractory Internal medicine Graves’ ophthalmopathy medicine Adverse effect 030203 arthritis & rheumatology disease Graves’ business.industry thyroid-associated ophthalmopathy lcsh:R General Medicine medicine.disease corticoid-resistant eye diseases ophthalmopathy Methylprednisolone chemistry 030221 ophthalmology & optometry medicine.symptom business Graves’ disease medicine.drug |
| Zdroj: | Journal of Clinical Medicine Volume 9 Issue 9 r-FISABIO. Repositorio Institucional de Producción Científica instname Journal of Clinical Medicine, Vol 9, Iss 2816, p 2816 (2020) r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante Journal of clinical medicine 2020, 9, 2816 Biblos-e Archivo. Repositorio Institucional de la UAM UCrea Repositorio Abierto de la Universidad de Cantabria r-FISABIO: Repositorio Institucional de Producción Científica Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO) Biblos-e Archivo: Repositorio Institucional de la UAM Universidad Autónoma de Madrid |
| ISSN: | 2077-0383 |
| DOI: | 10.3390/jcm9092816 |
| Popis: | Graves&rsquo orbitopathy (GO) is the most common extrathyroidal manifestation of Graves&rsquo 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&rsquo 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 &le 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. |
| Databáze: | OpenAIRE |
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