title: Long-term effects of tocilizumab therapy for refractory uveitis-related macular edema.
abstract: OBJECTIVE
  To report the long-term efficacy and safety of the interleukin-6 receptor antagonist tocilizumab for refractory uveitis-related macular edema (ME).
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Eyes with uveitis seen at a single tertiary referral center for which ME was the principal cause of reduced visual acuity.
  
  
  METHODS
  Data were obtained by standardized chart review.
  
  
  METHODS
  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 [logMAR]) were recorded during tocilizumab therapy at months 1, 3, 6, and 12.
  
  
  RESULTS
  Eleven eyes from 7 patients (all women) were included. Mean age was 43.4 years. Mean duration of ME was 14.2 years. Mean follow-up with tocilizumab therapy was 15.2 months (range, 12-18 months). Before tocilizumab therapy, conventional immunosuppressive therapy and 1 or more biologic agents failed in all patients. Uveitis diagnoses were birdshot chorioretinopathy (n = 3), juvenile idiopathic arthritis-associated uveitis (n = 3), and idiopathic panuveitis (n = 1). Mean CFT was 550 ± 226 μm at baseline, 389 ± 112 μm at month 1 (P = 0.007), 317 ± 88 μm at month 3 (P = 0.01), 292 ± 79 μm at month 6 (P = 0.006), and 274 ± 56 μm at month 12 of follow-up (P = 0.002). Mean logMAR best-corrected visual acuity improved from 0.67 ± 0.53 at baseline to 0.4 ± 0.56 at month 12 (P = 0.008). Tocilizumab therapy was withdrawn in 2 patients because of sustained remission at month 12. In both patients, ME relapsed 3 months after tocilizumab withdrawal. Reinitiation of tocilizumab therapy led to good uveitis control and ME resolution. Tocilizumab generally was well tolerated and no serious adverse events were reported.
  
  
  CONCLUSIONS
  In this study, tocilizumab was effective in the treatment of refractory inflammatory ME. No serious adverse events were observed.
authors.affiliation: Institut Clinic d'Oftalmologia, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Marina
authors.initials: M
authors.lastname: Mesquida
authors.affiliation: Fundació Clínic per a la Recerca Biomèdica, IDIBAPS, Barcelona, Spain.
authors.forename: Blanca
authors.initials: B
authors.lastname: Molins
authors.affiliation: Institut Clinic d'Oftalmologia, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Victor
authors.initials: V
authors.lastname: Llorenç
authors.affiliation: Institut Clinic d'Oftalmologia, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Maite
authors.initials: M
authors.lastname: Sainz de la Maza
authors.affiliation: Institut Clinic d'Oftalmologia, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain. Electronic address: amadan@clinic.ub.es.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Adán
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D005260:Female; D005584:Fovea Centralis / Q000473:pathology; D006801:Humans; D007275:Injections, Intravenous; D008269:Macular Edema / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014605:Uveitis / Q000150:complications / Q000188:drug therapy*; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D061067:Antibodies, Monoclonal, Humanized; C502936:tocilizumab