title: Efficacy of Anti-IL6-Receptor Tocilizumab in Refractory Cystoid Macular Edema of Birdshot Retinochoroidopathy Report of Two Cases and Literature Review.
abstract: OBJECTIVE
  To evaluate tocilizumab (TCZ) efficacy in severe and refractory birdshot chorioretinopathy (BSCR).
  
  
  METHODS
  Assessment of BSCR patients refractory to conventional immunosuppressive and anti-TNF-α drugs who underwent TCZ therapy.
  
  
  RESULTS
  Two HLA-A29 positive patients (man/37 years and woman/38 years; four affected eyes) with BSCR were studied. They had a chronic bilateral posterior uveitis. Patient 1 had been treated with intraocular and oral corticosteroids, cyclosporine A, and infliximab whereas Patient 2 received intravenous methylprednisolone pulses, cyclosporine A, azathioprine, and adalimumab. At TCZ onset they had macular edema (four eyes); visual acuity (VA) impairment (four eyes); vitritis (one eye); and diffuse angiographic signs of vasculitis (periphlebitis) (two eyes). Improvement of VA and OCT was observed following TCZ therapy in both patients. After a follow-up of 18 months (Patient 1) and 10 months (Patient 2), respectively, a corticosteroid sparing effect without any adverse effects was achieved in both cases.
  
  
  CONCLUSIONS
  TCZ was effective in two patients with BSCR refractory to anti-TNF-α agents.
authors.affiliation: a Rheumatology Division , Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria , Santander, Spain.
authors.forename: Vanesa
authors.initials: V
authors.lastname: Calvo-Río
authors.affiliation: a Rheumatology Division , Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria , Santander, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Blanco
authors.affiliation: a Rheumatology Division , Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria , Santander, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Santos-Gómez
authors.affiliation: b Rheumatology and Ophthalmology Divisions , Hospital Clinico Universitario San Carlos , Madrid, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Díaz-Valle
authors.affiliation: b Rheumatology and Ophthalmology Divisions , Hospital Clinico Universitario San Carlos , Madrid, Spain.
authors.forename: Esperanza
authors.initials: E
authors.lastname: Pato
authors.affiliation: a Rheumatology Division , Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria , Santander, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Loricera
authors.affiliation: a Rheumatology Division , Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria , Santander, Spain.
authors.forename: María C
authors.initials: MC
authors.lastname: González-Vela
authors.affiliation: c Ophthalmology Division , Hospital Universitario Marqués de Valdecilla, IDIVAL , Santander, Spain.
authors.forename: Rosalía
authors.initials: R
authors.lastname: Demetrio-Pablo
authors.affiliation: d Department of Medicine , Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF) , Santander , Spain.
authors.forename: José L
authors.initials: JL
authors.lastname: Hernández
authors.affiliation: a Rheumatology Division , Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria , Santander, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: González-Gay
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000080365:Birdshot Chorioretinopathy; D002825:Chorioretinitis / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008269:Macular Edema / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D019947:Receptors, Interleukin-6 / Q000037:antagonists & inhibitors*; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D019947:Receptors, Interleukin-6; D014409:Tumor Necrosis Factor-alpha; C502936:tocilizumab
keywords: Birdshot retinochoroidopathy; tocilizumab