Atienza-Mateo B, et al. - The experts aimed to evaluate the effectiveness of tocilizumab (TCZ) in refractory uveitis of Behcet’s disease (BD). A rapid and maintained improvement in all ocular parameters of the patients was noted with the use of TCZ. Therefore, in cases with BD and refractory uveitis, TCZ could be used as a therapeutic option.

Methods

• Authours conducted a multicentre study of patients having BD-associated uveitis.
• The patients included in the trial were refractory to conventional and biologic immunosuppressive drugs.
• Intraocular inflammation, macular thickness, visual acuity and corticosteroid-sparing effects were the primary outcome measures.

Results

• Eleven patients (7 men) (20 affected eyes) were studied herein.
• The median age was 35 years.
• Uveitis was found to be bilateral in 9 patients.
• Panuveitis (n = 8, with retinal vasculitis in 4), anterior uveitis (n = 2) and posterior uveitis (n = 1) were the patterns of ocular involvement.
• Seven patients presented with cystoid macular oedema.
• Data displayed that the clinical course was recurrent (n= 7) or chronic (n = 4).
• It was determined that the patients received systemic corticosteroids, conventional immunosuppressants and the following biologic agents : Adalimumab (n = 8), infliximab (n = 4), canakimumab (n = 1), golimumab (n = 3), etanercept (n = 1) before TCZ .
• Researchers used TCZ as a monotherapy or combined with conventional immunosuppressants at 8 mg/kg/i.v./4 weeks (n = 10) or 162 mg/s.c./week (n = 1).
• The following extraocular manifestations were present at TCZ onset: Oral and/or genital ulcers (n = 7), arthritis (n = 4), folliculitis/pseudofolliculitis (n = 4), erythema nodosum (n = 2), livedo reticularis (n = 1) and neurological involvement (n = 2).
• Rapid and maintained improvement were yielded by TCZ in all ocular parameters of the subjects, with complete recovery in 8 of them.
• For the extraocular manifestations, this was not the case, since TCZ was only efficacious in 3 patients.
• TCZ was withdrawn in 2 cases after a mean (S.D.) follow-up of 9.5 (8.05) months, because of a severe infusion reaction and arthritis impairment, respectively