Tocilizumab as an Effective Treatment Option in Children with Refractory Intermediate and Panuveitis

Abstract

Purpose: To describe the results of tocilizumab treatment in children with refractory non-anterior uveitis. Methods: A case series of seven children with refractory non-anterior uveitis (onset ≤16 years) with leakage on fluorescein angiogram (FA) were treated with tocilizumab intravenously every 4 weeks (eight mg/kg). Minimum follow-up was 6 months. Reported outcomes are changes in BCVA, central macular thickness (CMT) on OCT image, FA scores, dose of systemic steroids, complications and side effects. Results: In all patients, there was an improvement of macular edema and capillary leakage on FA. The median FA score decreased from 14 (10-18) at baseline to 8 (2-9) after 6 months of treatment (p = .018). The CMT decreased from 321 (314-384) to 295 (255-312) (p = .043). BCVA improved in five eyes and worsened in one eye due to cataract. No systemic or ocular complications were reported. Conclusion: Tocilizumab is an effective therapeutic option for reducing disease activity in children with refractory non-anterior uveitis.

Tocilizumab and Abatacept for the Treatment of Childhood Chronic Uveitis: A Monocentric Comparison Experience

“…As already identified ( 13 , 17 , 18 , 22 ) as a significant outcome in childhood, we confirmed the corticosteroid-sparing effect, systemic and topical, of Tocilizumab and Abatacept, albeit to a lesser extent for this latter.…”

“…According to recent data ( 17 ), children with optic disc swelling have been treated with Tocilizumab and showed a significant improvement and a decreased number of complications. No child with optic swelling has been treated with Abatacept.…”

Temporal Trends in Childhood Uveitis: Using Administrative Health Data to Investigate the Impact of Health Policy and Clinical Practice

“…9,10,14,15 The 2014 commencement of the multi-centre SYCAMORE (randomized controlled trial of the clinical effectiveness, safety and cost-effectiveness of adalimumab in combination with methotrexate for the treatment of juvenile idiopathic arthritis associated uveitis) trial, and the premature halt of the trial in March 2015 due to superior outcomes in the treatment group (adalimumab and methotrexate) brought increased attention to the use of systemic immunosuppressive agents in childhood uveitis. [8][9][10]16,17 A move away from infused anti-TNF agents (such as infliximab) to subcutaneous delivery of adalimumab may explain part of the early fall in hospitalizations post 2015, but not the ongoing year on year reductions in admissions. 17 The higher proportion of children admitted aged over 5 years (versus the younger age groups) despite the peak age of onset of JIA occurring between ages 2 and 4 suggests that hospitalisations are occurring in children who have long period of untreated or undertreated ocular disease, and that the reduction seen in these admissions over time is a result of increased use of agents such as anti-TNF therapies within JIA population.…”

Tocilizumab for the Treatment of Ocular Inflammatory Disease

“…Recognized TCZassociated adverse events occurred, but were manageable. Three original articles [20][21][22] and one letter 23 in this issue of Ocular Immunology & Inflammation address the use of TCZ for the treatment of ocular inflammatory disease.…”

“…Wennink et al 21 described their results using monthly TCZ, 8 mg/kg, to treat seven children with intermediate or panuveitis and severe, vision-threatening leakage of fluorescein angiography (FA) seen at a tertiary referral center in the Netherlands.…”