title: Treatment of active corticosteroid-resistant graves' orbitopathy.
abstract: OBJECTIVE
  To assess the efficacy of Tocilizumab, a humanized monoclonal antibody against the interleukin-6 receptor, in thyroid eye disease patients refractory to multiple intravenous steroids.
  
  
  METHODS
  Prospective interventional nonrandomized study including active GO defined by Clinical Activity Score (CAS) ≥4 patients resistant to previous intravenous steroids treated with Tocilizumab was conducted from February 2010 to September 2012. Snellen visual acuity, Hertel exophthalmometry, CAS evaluation, TSI levels, ocular motility, and side effects were registered at a 4-week interval.
  
  
  RESULTS
  Eighteen patients were included with a mean age of 47.9 ± 8.63 years. All patients had a significant progressive CAS improvement (mean CAS score reduction 5.89 ± 1.41 points, p< 0.00027). Mean TSI levels were significantly lower at the end of the treatment (mean -76.18% ± 17.80%, p = 0.00007). Thirteen patients (72.22%) reduced proptosis a mean of -3.92 ± 1.54 mm (p = 0.002). Fifteen patients (83.33%) had an improvement in extraocular motility, and 7 patients of 13 resolved their diplopia (53.85%). No severe side effects or relapse of active GO were observed at the end of follow up.
  
  
  CONCLUSIONS
  This study suggests that intravenous Tocilizumab may be effective on reducing activity in patients with thyroid eye disease refractory to intravenous steroids.
authors: *Centro Oftalmológico Moreiras, International Institute Orbit and Oculoplastics, Santiago de Compostela; †Orbit Unit, Clínica Piñero, Seville; and ‡Section of Rheumatology, Internal Medicine, Hospital Royo Villanova, Zaragoza, Spain.
authors: Jose Vicente
authors: JV
authors: Pérez-Moreiras
authors: Alejandro
authors: A
authors: Alvarez-López
authors: Estanislao Cardiel
authors: EC
authors: Gómez
mesh_terms: D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D004351:Drug Resistance; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D049970:Graves Ophthalmopathy / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D015850:Interleukin-6 / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009916:Orbital Diseases / Q000188:drug therapy* / Q000503:physiopathology; D011446:Prospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D005938:Glucocorticoids; C508600:IL6 protein, human; D007166:Immunosuppressive Agents; D015850:Interleukin-6; C502936:tocilizumab