Tocilizumab as first treatment option in optic neuropathy secondary to Graves’ orbitopathy

Pascual-Camps, Isabel; Molina-Pallete, R.; Bort-Martí, M.Á.; Todolí, José; España‐Gregori, Enrique

doi:10.1080/01676830.2018.1435694

Cited by 17 publications

(22 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Tocilizumab was first introduced as a treatment for severe glucocorticoid-resistant GO in 2009, with the first results published in a small case series [18]. The efficacy of tocilizumab was later supported by a randomized clinical trial in patients with active steroid-resistant GO [19], as well as by several case reports and case series [20][21][22][23][24][25][26][27][28][29].…”

Section: Introductionmentioning

confidence: 99%

Steroid-Resistant Graves’ Orbitopathy Treated with Tocilizumab in Real-World Clinical Practice: A 9-Year Single-Center Experience

Pérez-Moreiras¹,

Varela-Agra²,

Prada-Sánchez³

et al. 2021

JCM

View full text Add to dashboard Cite

This study aimed to assess the effectiveness and safety of tocilizumab use for the treatment of active steroid-resistant Graves’ orbitopathy (GO). A retrospective longitudinal study was conducted by reviewing the medical records at a single center between November 2009 and December 2018. A total of 114 patients with steroid-resistant Graves’ orbitopathy were examined and treated with tocilizumab, of which 54 adults met the inclusion criteria. No concomitant medication for the treatment of orbitopathy was used. The main primary outcomes included changes from baseline in the Clinical Activity Score (CAS) and thyrotropin receptor antibody (TRAb) levels throughout therapy with tocilizumab. The absolute responses to treatment were defined as the achievement of CAS ≤ 1 and TRAb ≤ 10 U/L. A composite ophthalmic score including CAS, proptosis, eyelid retraction, and diplopia was used to evaluate individual improvement in GO. Adverse drug reactions were also assessed. Analysis of the patient’s CAS and TRAb levels showed meaningful reductions during tocilizumab treatment. Differences between values at baseline and subsequent time points were statistically significant (p < 0.001 for all comparisons). The absolute CAS response (CAS = 0 or 1) was achieved in 74% (37/50) of patients after the fourth dose of tocilizumab (at week 16), with a TRAb response being achieved in 55% (23/42) of patients. The relative CAS response (reduction ≥ 2 points) was achieved in 90.9% of patients (40/44) after the first dose of tocilizumab (at week 4). Measurements of proptosis (reduction ≥ 2 mm in 78% of patients, 42/54) and eyelid retraction (reduction ≥ 2 mm in 75%, 33/44), and the prevalence of diplopia (improvement in 68%, 19/28) were significantly reduced after the last dose of tocilizumab (p < 0.001 for all comparisons). GO improved in 98% (53/54) of patients when at least two criteria of the composite evaluation were required. Four patients exhibited disease recurrence, defined as an increase in CAS of ≥2 points in the six months following the date of inactivation. Most adverse drug reactions were mild or moderate in severity. In conclusion, our data suggest that a course of at least 4 months (one monthly dose) of tocilizumab therapy provides a significant benefit to patients with active moderate-to-severe steroid-resistant GO.

show abstract

Section: Introductionmentioning

confidence: 99%

Steroid-Resistant Graves’ Orbitopathy Treated with Tocilizumab in Real-World Clinical Practice: A 9-Year Single-Center Experience

Pérez-Moreiras¹,

Varela-Agra²,

Prada-Sánchez³

et al. 2021

JCM

View full text Add to dashboard Cite

show abstract

“…A TNF α-blocker, infliximab, has been employed in one such case and noted positive results [138]. TCZ was used in 2 DON cases: one DON case was included in the initial cohort reported by Moreiras-Perez et al [122] and another one was reported by Pascual-Camps et al [139] very recently. In both cases, TCZ therapy was deemed successful.…”

Section: Therapy For Dysthyroid Optic Neuropathymentioning

confidence: 99%

Current and Future Treatments for Graves’ Disease and Graves’ Ophthalmopathy

Kotwal

Stan

2018

Horm Metab Res

View full text Add to dashboard Cite

The course and pathogenesis of Graves’ disease and Graves’ ophthalmopathy are interdependent, influencing each other’s therapeutic choices. Multiple factors including geographic location, access to medical services, patient and physician preferences influence the management of these conditions. Graves’ disease is classically managed with one of three treatment options – antithyroid drugs, radioactive iodine, and thyroidectomy. In recent years, there has been a shift towards antithyroid drugs, including long term therapy with these agents, given the advantage of avoiding hypothyroidism and the apparent safety of this approach. In addition, new therapies are (slowly) emerging, focusing on immunomodulation. Technological advances are opening doors to non-pharmaceutical interventions that aim to deal with both structural thyroid abnormalities as well as biochemical abnormalities of hyperthyroidism. Graves’ ophthalmopathy management is guided by its activity and severity status, with treatment options including smoking cessation, control of hyperthyroidism, local eye measures, glucocorticoids, selenium, orbital radiotherapy, and surgery. In addition to these established treatment choices, new immunotherapy-based approaches are being tested. Some of them (tocilizumab and teprotumumab) are very promising but further evaluation is needed before we can establish their role in clinical care. Agents identified as beneficial in Graves’ disease management will likely be tested in Graves’ ophthalmopathy as well. In the coming years, our main clinical responsibility will be to find the proper balance between the benefits and potential risks of these incoming therapies, and to identify the subgroups of patients where this ratio is most likely to favor a safe and successful therapeutic outcome.

show abstract

“…Orbital radiotherapy is indicated as adjuvant treatment. Some case reports describe the use of new immunological treatment (as tocilizumab) 14 but given the lack of larger scale studies, we cannot consider these treatments as conventional DON therapy. So far, just one randomized study compares medical versus surgical treatment for DON 3 leading to EUGOGO recommendations for intra-venous corticoids as first-line treatment before surgery.…”

Section: Don Represents Both Diagnostic and Therapeutic Challengesmentioning

confidence: 99%

“…The follow-up data were collected between 2 and 46 months after the last treatment for each patient (median follow-up at 8 months;[4][5][6][7][8][9][10][11][12][13][14]. The follow-up data were collected between 2 and 46 months after the last treatment for each patient (median follow-up at 8 months;[4][5][6][7][8][9][10][11][12][13][14].…”

mentioning

confidence: 99%

Sight‐threatening Graves’ orbitopathy: Twenty years’ experience of a multidisciplinary thyroid‐eye outpatient clinic

Tramunt

Imbert²,

Grunenwald

et al. 2018

Clinical Endocrinology

View full text Add to dashboard Cite

Context: Sight-threatening Graves' orbitopathy affects 3% to 5% of patients with Graves' orbitopathy.Objectives: To describe the management of patients with sight-threatening Graves' orbitopathy seen in a multidisciplinary thyroid-eye outpatient clinic dedicated to Graves' orbitopathy (GO). Patients and methods:We enrolled all patients with sight-threatening GO (dysthyroid optic neuropathy and corneal ulcer as defined in the EUGOGO statement) seen and treated in our GO multidisciplinary thyroid-eye outpatient clinic over the last two decades.Results: A total of 31 patients (median age 51 years old) including 24 women (77%) and 58% active smokers. This population represented 47 cases (case = eye) of sightthreatening GO. Dysthyroid optic neuropathy (DON) occurred in 40 eyes, corneal ulcer in 15 eyes and both in 8. At presentation, the clinical features of DON were reduced visual acuity (85%), visual field defects (80%), optic disc swelling (42%) and reduced colour vision (100%). At one year, surgical orbital decompression (OD) was performed in 82.5% of DON cases. Only seven eyes with DON were treated with pulses of intra-venous glucocorticoids. For 10 patients, several therapeutic strategies (OD n = 4, punctal plug n = 1, amniotic membrane graft n = 2, tarsorrhaphy n = 2, botulinum toxin injection = 3 and eyelid surgery n = 2) were used to treat corneal ulcer. For each ophthalmological parameter, more than 85% of DON cases had recovery or improvement after treatment. For visual acuity in corneal ulcer, it was 71.4%. Conclusion:We report 47 cases of sight-threatening GO. Orbital decompression was performed in the majority of DON cases and several therapeutic strategies were necessary to treat corneal ulcer. The results are satisfactory in sight-threatening Graves' orbitopathy due to multidisciplinary management. K E Y W O R D Scornea, dysthyroid optic neuropathy, orbital decompression, sight-threatening Graves' orbitopathy | 209TramunT eT al.

show abstract

Tocilizumab as first treatment option in optic neuropathy secondary to Graves’ orbitopathy

Cited by 17 publications

References 9 publications

Steroid-Resistant Graves’ Orbitopathy Treated with Tocilizumab in Real-World Clinical Practice: A 9-Year Single-Center Experience

Steroid-Resistant Graves’ Orbitopathy Treated with Tocilizumab in Real-World Clinical Practice: A 9-Year Single-Center Experience

Current and Future Treatments for Graves’ Disease and Graves’ Ophthalmopathy

Sight‐threatening Graves’ orbitopathy: Twenty years’ experience of a multidisciplinary thyroid‐eye outpatient clinic

Contact Info

Product

Resources

About