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Abstract: Graves? orbitopathy (GO) is the most common extrathyroidal manifestation of Graves? disease (GD). Our aim was to assess the ecacy 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 After a mean follow-up of 16.1 2.1 months, low disease activity (CAS 3), was achieved in 88 eyes (92.6%) and TCZ was withdrawn in 29 cases due to low disease activity (n = 25) or inecacy (n = 4). No serious adverse events were observed. In conclusion, TCZ is a useful and safe therapeutic option in refractory GO treatment.
Fuente: Journal of clinical medicine 2020, 9, 2816
Editorial: MDPI
Año de publicación: 2020
Nº de páginas: 14
Tipo de publicación: Artículo de Revista
DOI: 10.3390/jcm9092816
ISSN: 2077-0383
Url de la publicación: https://doi.org/10.3390/jcm9092816
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LARA SÁNCHEZ-BILBAO
DAVID MARTÍNEZ-LÓPEZ
MARCELINO REVENGA
ÁNGEL LÓPEZ-VÁZQUEZ
ELIA VALLS-PASCUAL
BELÉN ATIENZA-MATEO
BEATRIZ VALLS-ESPINOSA
OLGA MAIZ-ALONSO
ANA BLANCO
IGNACIO TORRE-SALABERRI
VERÓNICA RODRÍGUEZ-MÉNDEZ
ÁNGEL GARCÍA-APARICIO
RAÚL VEROZ-GONZÁLEZ
VEGA JOVANÍ
DIANA PEITEADO
MARGARITA SÁNCHEZ-ORGAZ
EVA TOMERO
JOSE LUIS HERNANDEZ HERNANDEZ
MIGUEL ANGEL GONZALEZ-GAY MANTECON
RICARDO BLANCO ALONSO
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