Tocilizumab for the Management of Corticosteroid-Resistant Mild to Severe Graves' Ophthalmopathy, a Report of Three Cases

Ocul Immunol Inflamm. 2020;28(2):281-284. doi: 10.1080/09273948.2018.1545914. Epub 2018 Nov 20.

Abstract

Purpose: To discuss the use of tocilizumab in mild to severe Graves' ophthalmopathy as corticosteroid-adjunctive therapy. Methods: Retrospective case reports.Results: Three patients with corticosteroid-resistant or advanced diplopia-associated Graves' ophthalmopathy were subsequently treated with monthly intravenous tocilizumab at a dose of 8 mg/kg. None reported a past or present history of dysthyroidism. The adjunction of interleukin-6-receptor monoclonal antibody treatment was associated with a significant improvement in ocular symptoms, notably diplopia and proptosis, and functional prognosis in all patients, with one relapse approximately two months after the end of the treatment.Conclusion: These clinical reports confirm the relative efficacy and tolerability profile of intravenous tocilizumab in severe or corticosteroid-resistant Graves' ophthalmopathy.

Keywords: Biotherapies; EUGOGO; Graves’ ophthalmopathy; proptosis; tocilizumab.

Publication types

  • Case Reports
  • Letter

MeSH terms

  • Aged
  • Antibodies, Monoclonal, Humanized / administration & dosage*
  • Dose-Response Relationship, Drug
  • Drug Resistance*
  • Female
  • Glucocorticoids / pharmacology*
  • Graves Ophthalmopathy / diagnosis
  • Graves Ophthalmopathy / drug therapy*
  • Humans
  • Injections, Intravenous
  • Magnetic Resonance Imaging / methods
  • Middle Aged
  • Severity of Illness Index

Substances

  • Antibodies, Monoclonal, Humanized
  • Glucocorticoids
  • tocilizumab