Tocilizumab for thyroid eye disease

Abstract

The aim of this review was to find out if tocilizumab is helpful for the treatment of thyroid eye disease (TED). Cochrane researchers searched for studies to answer this question and found no relevant studies. Key messages At present, there is no evidence from well-designed studies to show that tocilizumab works, and has no side e ects, for people with TED. What was studied in this review? TED is a common condition. TED is an autoimmune disease which means that a person's own immune system attacks and damages the eye and eye socket (orbit). Current treatments for TED include glucocorticosteroids, radiation and surgery. These treatments may have significant undesirable side e ects. Tocilizumab is a drug that suppresses the immune system. It is used to treat other autoimmune diseases such as rheumatoid arthritis and systemic juvenile idiopathic arthritis. Tocilizumab has been used to treat people with TED and there are reports that it works. What are the main results of the review? The Cochrane researchers found no completed studies that met the standard to be included in this review.

The 2021 European Group on Graves’ orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves’ orbitopathy

“…Tocilizumab is a humanized monoclonal antibody against the interleukin (IL)-6 receptor approved for use in rheumatoid arthritis. In addition to playing a role on T and B cell activation as proinflammatory cytokine, IL-6 also acts directly on orbital pre-adipocytes to promote volume expansion (147). In an RCT of GO patients considered to have failed initial glucocorticoid therapy (n=32), subjects treated with iv tocilizumab monotherapy on week 0, 4, 8, 12 showed greater reductions in CAS (86% achieving CAS <3 vs 35% in the placebo group, p<0.005) at week 16 (148).…”

Adaptation of the hypothalamo-pituitary-thyroid and hypothalamo-pituitary-adrenal systems to a new infectious disease - COVID-19 in the development of COVID-19 pneumonia and/or cytokine storm

“…К счастью для эндокринологов, моноклональное антитело, эффективно позволяющее блокировать цитокиновый шторм (важное звено возможного фатального прогноза при СОVID-19; Тоцилизумаб -моноклональное антитело против ИЛ-6, экспрессирующегося на адипоцитах, фибробластах и макрофагах, что приводит к формированию ЭОП), уже разрешено для лечения офтальмопатии FDA [30,31], и, таким образом, проводя данную терапию, мы не должны рассматривать ее с позиций негативных влияний на эндокринную систему.…”

“…Тоцилизумаб является биологическим агентом, который успешно применяется и при других АИЗ, например, при ревматоидном артрите. Некоторые исследования [30] продемонстрировали эффективность Тоцилизумаба при лечении пациентов с активной ЭОП средней и тяжелой степени тяжести, но нет четких рекомендаций относительно его применения [32].…”

A New Era in the Treatment of Thyroid Eye Disease

“…3,11 Clearly, there is an unmet need for safe and specific disease-modifying treatments. [11][12][13] TED can severely impact quality of life and socioeconomic status, 1,14,15 with proptosis and diplopia most significantly affecting quality of life. 1,4,10 Proptosis can drastically alter a patient's appearance and decrease or threaten vision in severe cases.…”

“…32,38 Such treatment strategies can provide short-term relief, but have no long-term disease-modifying capability and do not improve proptosis and strabismus, as shown in multiple studies. 11,12,13,32,34,37,38 Intravenous pulse steroid administration is often preferable to oral administration, based on short-term reduction of clinical activity score (CAS) and adverse event (AE) profiles. 2,12 However, high-dose glucocorticoid administration is associated with significant and potentially life-threatening side effects including Cushingoid features, hypertension, hyperglycemia, mood changes, osteoporosis, and weight gain.…”