Anti-IL-6 Receptor Tocilizumab in Refractory Graves’ Orbitopathy: National Multicenter Observational Study of 48 Patients
Abstract
:1. Introduction
2. Patients and Methods
2.1. Patients, Enrollment Criteria and Study Design
2.2. Outcome Variables
2.3. Data Collection
2.4. Statistical Analysis
3. Results
3.1. Main Clinical Features at Tocilizumab Onset
3.2. Treatment with Tocilizumab and Efficacy
3.3. Follow-Up and Side Effects of Tocilizumab Therapy
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Appendix A
References
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Number of Patients/Eyes Affected, n/n | 48/95 * |
---|---|
Age, mean (SD), years | 50.96 (11.8) |
Sex, men/women, n/n (%) | 10/38 (20.8/79.2) |
Duration GD in years before TCZ, median (IQR) | 1.8 (0.7–4.0) |
Duration GO in years before TCZ, median (IQR) | 0.9 (0.0–2.4) |
Thyroidopathy family history, n (%) | 12 (25) |
Smoking, n (%) | 25 (52.1) |
Comorbidities, n (%) | |
Hypertension | 14 (29.2) |
Diabetes mellitus | 6 (12.5) |
Dyslipidemia | 12 (25) |
Others | 16 (33.3) |
Hormones, mean (SD) | |
T4 (ref. 0.8–1.8 ng/dL) | 4.04 (8.08) |
T3 (ref. 2.3–4.2 pg/mL) | 4.18 (4.26) |
TSH (ref. 0.55–4.78 mIU/L) | 4.46 (18.98) |
Antithyroid antibodies, (%)/mean (SD) mcg/dL | |
TSI/TRAb (ref. 0–0.7 U/L) | 77%/17.3 (19.3) 1 |
GO complications present before treatment, n (eyes) (%) | |
Exophthalmos | 57 (60) |
Strabismus | 40 (42.1) |
Muscle fibrosis | 41 (43.2) |
DON | 7 (14.7) |
Previous treatment to TCZ onset, n (%) | |
Pulses of IVMP | 43 (89.6) |
Selenium | 11 (22.9) |
Decompressive surgery | 7 (14.58) |
Regimen of TCZ therapy | |
Monotherapy/combined treatment, n (%) | 45/3 (93.8/6.2) |
AZA | 1 (2.1) |
MTX | 2 (4.2) |
TCZ dosage, n (%) | |
8 mg/kg/IV/4 weeks | 43 (89.6) |
162 mg/s.c./week | 5 (10.4) |
Follow-up on TCZ therapy, mean (SD), months | 16.05 ± 2.06 |
Low disease activity, n (%) | 79 (83.2) |
Discontinuation treatment, n (%) | 29 (60.4) |
Low disease activity | 25 (86.2) |
Inefficacy | 4 (13.8) |
Side effects/toxicity | 0 |
Relapses number | 0 |
Severe side effects, n (per 100 patients/year) | 0 |
Baseline n = 95 | Month 1 n = 87 | Month 3 n = 85 | Month 6 n = 85 | Month 12 n = 83 | |
---|---|---|---|---|---|
Low disease activity | NA | 29 (33.33) * | 54 (63.53) * | 62 (72.94) * | 72 (86.75) * |
Clinical response in CAS | NA | 43 (49.42) * | 64 (75.29) * | 76 (89.41) * | 79 (95.18) * |
Spontaneous retroocular pain | 42 (44.21) | 28 (32.18) | 11 (12.94) * | 5 (5.88) * | 0 (0) * |
Pain on eye movement | 52 (54.73) | 41 (47.13) | 36 (42.35) | 18 (21.17) * | 2 (2.41) * |
Eyelids redness | 42 (44.21) | 35 (40.23) | 28 (32.94) | 12 (14.12) * | 9 (10.84) * |
Conjunctival redness | 74 (77.89) | 56 (64.37) | 57 (67.05) | 33 (38.83) * | 16 (19.28) * |
Caruncular edema | 44 (46.31) | 38 (43.67) | 16 (18.82) * | 13 (15.29) * | 7 (8.43) * |
Eyelids edema | 77 (81.05) | 64 (73.56) | 69 (81.17) | 57 (67.05) * | 47 (56.63) * |
Outcome in chemosis | 54 (56.84) | 37 (42.53) | 40 (47.05) | 22 (25.88) * | 14 (16.87) * |
Proptosis (>2 mm) | ND | 25 (28.74) | 16 (18.82) | 11 (12.64) * | 5 (6.02) * |
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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.; et al. Anti-IL-6 Receptor Tocilizumab in Refractory Graves’ Orbitopathy: National Multicenter Observational Study of 48 Patients. J. Clin. Med. 2020, 9, 2816. https://doi.org/10.3390/jcm9092816
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, et al. Anti-IL-6 Receptor Tocilizumab in Refractory Graves’ Orbitopathy: National Multicenter Observational Study of 48 Patients. Journal of Clinical Medicine. 2020; 9(9):2816. https://doi.org/10.3390/jcm9092816
Chicago/Turabian StyleSánchez-Bilbao, Lara, David Martínez-López, Marcelino Revenga, Ángel López-Vázquez, Elia Valls-Pascual, Belén Atienza-Mateo, Beatriz Valls-Espinosa, Olga Maiz-Alonso, Ana Blanco, Ignacio Torre-Salaberri, and et al. 2020. "Anti-IL-6 Receptor Tocilizumab in Refractory Graves’ Orbitopathy: National Multicenter Observational Study of 48 Patients" Journal of Clinical Medicine 9, no. 9: 2816. https://doi.org/10.3390/jcm9092816