title: Outcome of tocilizumab treatment in refractory ocular inflammatory diseases.
abstract: OBJECTIVE
  To report the outcomes of tocilizumab treatment for refractory ocular inflammatory diseases.
  
  
  METHODS
  A retrospective case series of 17 patients (28 eyes) diagnosed with recalcitrant ocular inflammatory diseases including uveitis (10 cases), scleritis (six cases) and orbital pseudotumour (one case), who received tocilizumab between April 2010 and March 2015. All patients were initiated with treatment of 4 mg/kg or 8 mg/kg tocilizumab. The primary outcome was absence of inflammation and achievement of steroid sparing at 6 and 9 months. Secondary outcomes were change in visual acuity and major adverse effects of tocilizumab causing discontinuation of the treatment.
  
  
  RESULTS
  Mean age at initiation of tocilizumab was 41 ± 16 years. Prior to tocilizumab treatment, all patients underwent unsuccessful conventional immunosuppressive therapy while 94% of patients (16/17) failed treatment with various biological agents. After tocilizumab administration, control of inflammation and steroid sparing were achieved in 63% and 71% of uveitis patients at 6 and 9 months, while 50% of scleritis patients achieved the primary outcome at 6 and 9 months. Mean duration of tocilizumab therapy was 12.6 ± 10.0 (range, 2-35) months. Three of four patients who had a follow-up of at least 18 (range, 18-35) months experienced quiescent inflammation for up to 32 months of tocilizumab use until last visit. Four patients (24%) discontinued tocilizumab due to serious side effects including neutropenia, unacceptable dizziness and nausea, severe angioedema and severe abdominal pain.
  
  
  CONCLUSIONS
  Our series demonstrated moderate efficacy of tocilizumab in recalcitrant uveitis and scleritis. Serious adverse effects were not uncommon.
authors.affiliation: Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA.|Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA.|Department of Ophthalmology, Faculty of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand.
authors.forename: Sukhum
authors.initials: S
authors.lastname: Silpa-Archa
authors.affiliation: Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA.|Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA.|Department of Ophthalmology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
authors.forename: Merih
authors.initials: M
authors.lastname: Oray
authors.affiliation: Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA.|Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA.
authors.forename: Janine M
authors.initials: JM
authors.lastname: Preble
authors.affiliation: Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA.|Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA.|Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Charles Stephen
authors.initials: CS
authors.lastname: Foster
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D016727:Orbital Pseudotumor / Q000175:diagnosis / Q000188:drug therapy*; D012189:Retrospective Studies; D015423:Scleritis / Q000175:diagnosis / Q000188:drug therapy*; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014605:Uveitis / Q000175:diagnosis / Q000188:drug therapy*; D014792:Visual Acuity; D000093242:Interleukin-6 Inhibitors; D015850:Interleukin-6
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000093242:Interleukin-6 Inhibitors; C508600:IL6 protein, human; D015850:Interleukin-6; C502936:tocilizumab
keywords: inflammation; scleritis; tocilizumab; uveitis