Anti-IL-6 receptor Tocilizumab in refractory graves’ orbitopathy: national multicenter observational study of 48 patients
Autor (es)
Sánchez-Bilbao, Lara; Martínez-López, David; Revenga, Marcelino; López-Vázquez, Ángel; Valls-Pascual, Elia; Atienza-Mateo, Belén; Rodríguez-Méndez, Verónica; García-Aparicio, Ángel; Veroz-González, Raúl; Jovaní, Vega; Peiteado, Diana; Sánchez-Orgaz, Margarita; Tomero, Eva; Toyos-Sáenz de Miera, Francisco J.; Pinillos, Valvanera; Aurrecoechea, Elena; Mora, Ángel; Conesa, Arantxa Conesa; Fernández-Prada, Manuel; Troyano, Juan A.; Calvo-Río, Vanesa; Demetrio-Pablo, Rosalía; González-Mazón, Íñigo; Hernández, José L.; Castañeda Sanz, Santos; González-Gay, Miguel A.; Blanco, RicardoEntidad
UAM. Departamento de Medicina; Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-IP)Editor
MDPI, Basel, SMwitzerlandFecha de edición
2020-08-31Cita
10.3390/jcm9092816
Journal of Clinical Medicine 9.9 (2020): 2816
ISSN
2077-0383DOI
10.3390/jcm9092816Financiado por
This work was also partially supported by RETICS Programs, RD08/0075 (RIER) and RD12/0009/0013 from “Instituto de Salud Carlos III” (ISCIII) (Spain).Proyecto
Gobierno de España. RD08/0075; Gobierno de España. RD12/0009/0013Versión del editor
http://doi.org/10.3390/jcm9092816Materias
Graves’ disease; extrathyroidal manifestations; thyroid-associated ophthalmopathy; Graves’ ophthalmopathy; corticoid-resistant; Tocilizumab; MedicinaDerechos
© 2020 The AuthorsResumen
Graves’ orbitopathy (GO) is the most common extrathyroidal manifestation of Graves’
disease (GD). Our aim was to assess the e cacy and safety of Tocilizumab (TCZ) in GO refractory to conventional therapy. This was an open-label multicenter study of glucocorticoid-resistant GO treated with TCZ. The main outcomes were the best-corrected visual acuity (BVCA), Clinical Activity
Score (CAS) and intraocular pressure (IOP). These outcome variables were assessed at baseline, 1st,
3rd, 6th and 12th month after TCZ therapy onset. The severity of GO was assessed according to
the European Group on Graves’ Orbitopathy (EUGOGO). We studied 48 (38 women and 10 men)
patients (95 eyes); mean age + standard deviation 51 + 11.8 years. Before TCZ and besides oral
glucocorticoids, they had received IV methylprednisolone (n = 43), or selenium (n = 11). GO disease
was moderate (n =29) or severe (n = 19) and dysthyroid optic neuropathy (DON) (n = 7). TCZ was
used in monotherapy (n = 45) or combined (n = 3) at a dose of 8 mg/kg IV every four weeks (n = 43)
or 162 mg/s.c. every week (n = 5). TCZ yielded a significant improvement in all of the main outcomes
at the 1st month that was maintained at one year. Comparing the baseline with data at 1 year all of
the variables improved; BCVA (0.78 +- 0.25 vs. 0.9 +- 0.16; p = 0.0001), CAS (4.64 +- 1.5 vs. 1.05 +- 1.27;
p = 0.0001) and intraocular pressure (IOP) (19.05 4.1 vs. 16.73 3.4 mmHg; p = 0.007). After a mean
follow-up of 16.1 +- 2.1 months, low disease activity (CAS +- 3), was achieved in 88 eyes (92.6%) and
TCZ was withdrawn in 29 cases due to low disease activity (n = 25) or ineffcacy (n = 4). No serious adverse events were observed. In conclusion, TCZ is a useful and safe therapeutic option in refractory GO treatment
Lista de ficheros
Google Scholar:Sánchez-Bilbao, Lara
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Martínez-López, David
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Revenga, Marcelino
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López-Vázquez, Ángel
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Valls-Pascual, Elia
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Atienza-Mateo, Belén
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Rodríguez-Méndez, Verónica
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García-Aparicio, Ángel
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Veroz-González, Raúl
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Jovaní, Vega
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Peiteado, Diana
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Sánchez-Orgaz, Margarita
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Tomero, Eva
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Toyos-Sáenz de Miera, Francisco J.
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Pinillos, Valvanera
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Aurrecoechea, Elena
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Mora, Ángel
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Conesa, Arantxa Conesa
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Fernández-Prada, Manuel
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Troyano, Juan A.
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Calvo-Río, Vanesa
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Demetrio-Pablo, Rosalía
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González-Mazón, Íñigo
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Hernández, José L.
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Castañeda Sanz, Santos
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González-Gay, Miguel A.
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Blanco, Ricardo
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