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Sánchez-Bilbao L, Martínez-López D, Revenga M, López-Vázquez Á, Valls-Pascual E, Atienza-Mateo B, Valls-Espinosa B, Maiz-Alonso O, Blanco A, Torre-Salaberri I, Rodríguez-Méndez V, García-Aparicio Á, Veroz-González R, Jovaní V, Peiteado D, Sánchez-Orgaz M, Tomero E, Toyos-Sáenz de Miera FJ, Pinillos V, Aurrecoechea E, Mora Á, Conesa A, Fernández-Prada M, Troyano JA, Calvo-Río V, Demetrio-Pablo R, González-Mazón Í, Hernández JL, Castañeda S, González-Gay MÁ, Blanco R. Anti-IL-6 Receptor Tocilizumab in Refractory Graves' Orbitopathy: National Multicenter Observational Study of 48 Patients. J Clin Med 2020; 9:jcm9092816. [PMID: 32878150 PMCID: PMC7563792 DOI: 10.3390/jcm9092816] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/18/2020] [Accepted: 08/29/2020] [Indexed: 12/14/2022] Open
Abstract
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.
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Affiliation(s)
- Lara Sánchez-Bilbao
- Rheumatology, Ophthalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, 39008 Santander, Spain; (L.S.-B.); (D.M.-L.); (B.A.-M.); (V.C.-R.); (R.D.-P.); (Í.G.-M.); (J.L.H.)
| | - David Martínez-López
- Rheumatology, Ophthalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, 39008 Santander, Spain; (L.S.-B.); (D.M.-L.); (B.A.-M.); (V.C.-R.); (R.D.-P.); (Í.G.-M.); (J.L.H.)
| | - Marcelino Revenga
- Rheumatology and Ophthalmology, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (M.R.); (Á.L.-V.)
| | - Ángel López-Vázquez
- Rheumatology and Ophthalmology, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (M.R.); (Á.L.-V.)
| | - Elia Valls-Pascual
- Rheumatology and Ophthalmology, Hospital Universitari Doctor Peset, 46017 Valencia, Spain; (E.V.-P.); (B.V.-E.)
| | - Belén Atienza-Mateo
- Rheumatology, Ophthalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, 39008 Santander, Spain; (L.S.-B.); (D.M.-L.); (B.A.-M.); (V.C.-R.); (R.D.-P.); (Í.G.-M.); (J.L.H.)
| | - Beatriz Valls-Espinosa
- Rheumatology and Ophthalmology, Hospital Universitari Doctor Peset, 46017 Valencia, Spain; (E.V.-P.); (B.V.-E.)
| | - Olga Maiz-Alonso
- Rheumatology and Ophthalmology, Hospital Universitario de Donosti, 20014 San Sebastián, Spain; (O.M.-A.); (A.B.)
| | - Ana Blanco
- Rheumatology and Ophthalmology, Hospital Universitario de Donosti, 20014 San Sebastián, Spain; (O.M.-A.); (A.B.)
| | - Ignacio Torre-Salaberri
- Rheumatology and Ophthalmology, Hospital Universitario de Basurto, 48013 Bilbao, Spain; (I.T.-S.); (V.R.-M.)
| | - Verónica Rodríguez-Méndez
- Rheumatology and Ophthalmology, Hospital Universitario de Basurto, 48013 Bilbao, Spain; (I.T.-S.); (V.R.-M.)
| | | | | | - Vega Jovaní
- Rheumatology, Hospital General Universitario de Alicante, 03010 Alicante, Spain;
| | - Diana Peiteado
- Rheumatology and Ophthalmology, Hospital Universitario La Paz, 28046 Madrid, Spain; (D.P.); (M.S.-O.)
| | - Margarita Sánchez-Orgaz
- Rheumatology and Ophthalmology, Hospital Universitario La Paz, 28046 Madrid, Spain; (D.P.); (M.S.-O.)
| | - Eva Tomero
- Rheumatology, Hospital de La Princesa, IIS-Princesa, 28006 Madrid, Spain; (E.T.); (S.C.)
| | | | | | - Elena Aurrecoechea
- Rheumatology and Ophthalmology, Hospital Sierrallana, 39300 Torrelavega, Spain; (E.A.); (Á.M.)
| | - Ángel Mora
- Rheumatology and Ophthalmology, Hospital Sierrallana, 39300 Torrelavega, Spain; (E.A.); (Á.M.)
| | - Arantxa Conesa
- Rheumatology, Hospital Clínico Universitario de Valencia, 46018 Valencia, Spain;
| | | | - Juan A. Troyano
- Ophthalmology, Hospital Universitario Clínico San Carlos, 28040 Madrid, Spain;
| | - Vanesa Calvo-Río
- Rheumatology, Ophthalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, 39008 Santander, Spain; (L.S.-B.); (D.M.-L.); (B.A.-M.); (V.C.-R.); (R.D.-P.); (Í.G.-M.); (J.L.H.)
| | - Rosalía Demetrio-Pablo
- Rheumatology, Ophthalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, 39008 Santander, Spain; (L.S.-B.); (D.M.-L.); (B.A.-M.); (V.C.-R.); (R.D.-P.); (Í.G.-M.); (J.L.H.)
| | - Íñigo González-Mazón
- Rheumatology, Ophthalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, 39008 Santander, Spain; (L.S.-B.); (D.M.-L.); (B.A.-M.); (V.C.-R.); (R.D.-P.); (Í.G.-M.); (J.L.H.)
| | - José L. Hernández
- Rheumatology, Ophthalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, 39008 Santander, Spain; (L.S.-B.); (D.M.-L.); (B.A.-M.); (V.C.-R.); (R.D.-P.); (Í.G.-M.); (J.L.H.)
| | - Santos Castañeda
- Rheumatology, Hospital de La Princesa, IIS-Princesa, 28006 Madrid, Spain; (E.T.); (S.C.)
- Cátedra UAM-Roche, EPID-Future, Universidad Autónoma de Madrid (UAM), 28049 Madrid, Spain
| | - Miguel Á. González-Gay
- Rheumatology, Ophthalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, 39008 Santander, Spain; (L.S.-B.); (D.M.-L.); (B.A.-M.); (V.C.-R.); (R.D.-P.); (Í.G.-M.); (J.L.H.)
- Correspondence: (M.Á.G.-G.); (R.B.)
| | - Ricardo Blanco
- Rheumatology, Ophthalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, 39008 Santander, Spain; (L.S.-B.); (D.M.-L.); (B.A.-M.); (V.C.-R.); (R.D.-P.); (Í.G.-M.); (J.L.H.)
- Correspondence: (M.Á.G.-G.); (R.B.)
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