Vanesa Calvo-Río1, Ricardo Blanco1, Montserrat Santos-Gómez1, David Díaz-Valle2, Esperanza Pato2, Javier Loricera1, María C González-Vela1, Rosalía Demetrio-Pablo3, José L Hernández4, Miguel A González-Gay1. 1. a Rheumatology Division , Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria , Santander, Spain. 2. b Rheumatology and Ophthalmology Divisions , Hospital Clinico Universitario San Carlos , Madrid, Spain. 3. c Ophthalmology Division , Hospital Universitario Marqués de Valdecilla, IDIVAL , Santander, Spain. 4. 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.
Abstract
PURPOSE: 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.
PURPOSE: 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: Mathilde Leclercq; M Le Besnerais; V Langlois; N Girszyn; Y Benhamou; C Ngo; H Levesque; M Muraine; J Gueudry Journal: Clin Rheumatol Date: 2018-02-03 Impact factor: 2.980
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