Tocilizumab for uveitic macular edema

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Abstract

Purpose

To report the outcomes of tocilizumab (TCZ) treatment for uveitic cystoid macular edema (UCME) refractory to immunomodulatory therapy.

Methods

Five refractory patients with UCME who received TCZ between January and August 2012 were identified by retrospective chart review. All patients received 8 mg/kg TCZ at 4 week intervals. Data regarding patient demographics, use of immunosuppressive (IS) drugs, biologic agents or intravitreal therapies prior to TCZ infusions were gathered. Main outcome measures: Central foveal thickness (CFT) measured by optical coherence tomography, degree of anterior and posterior chamber inflammation (Standardization of Uveitis Nomenclature Working Group criteria), and visual acuity (logarithm of the minimum angle of resolution [log-MAR]) were recorded at month 1, 3, and 6.

Results

Eight eyes from 5 patients (all females) were included. Mean age was 49.4 years (range, 30-68). Mean follow-up was 8.4 months (range, 6-12). Before TCZ, all patients received and failed conventional IS therapy and had received at least 1 another biologic agent. Uveitis diagnoses were: Birdshot chorioretinopathy (n=3), juvenile idiopathic arthritis-associated uveitis (n=1), and idiopathic panuveitis (n=1). Mean baseline CFT (95% confidence interval) was 602 ± 236 μm in baseline, 386 ± 113 μm at month 1 (p= 0.006), 323 ± 103 μm at month 3 (p= 0.026) and 294.5 ± 94.5 μm at month 6 (p= 0.014). Median log-MAR best-corrected visual acuity (BCVA) improved from 0.66 ± 0.57 in baseline to 0.47 ± 0.62 at month 6 (p = 0.035). After 6 months, an improvement of ≥ 2 lines of BCVA was observed in 50% of eyes (p= 0.028). Sustained uveitis remission was achieved in all patients. No AE were reported.

Conclusion

These data suggest that TCZ is effective for treating UCME in otherwise refractory cases.

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