Tocilizumab versus Rituximab in Patients with Moderate to Severe Steroid-resistant Graves' Orbitopathy

Ocul Immunol Inflamm. 2022 Feb 17;30(2):500-505. doi: 10.1080/09273948.2020.1808688. Epub 2020 Sep 23.

Abstract

Introduction: To describe the efficacy of tocilizumab in patients with Graves' orbitopathy resistant or dependent to steroids and compare to rituximab treated patients.

Patients and methods: Graves's orbitopathy response was considered as decrease of at least 2 points of the CAS.

Results: Twenty-one patients were included, 7 patients were treated with tocilizumab and 14 with rituximab. The primary was achieved in all 7 patients (100%) on tocilizumab and 9 out of 14 patients on (64%) rituximab (p = .17). Mean change in CAS was consistent with a decrease of 3.3 ± 0.5 points in patients on tocilizumab versus 2.5 ± 1.9 in patients on rituximab (p = .07). One patient on tocilizumab (14%) and 4 patients (29%) on rituximab experienced significant relapse during the follow-up. The difference in relapse-free survival was not significant in patients on tocilizumab (10.8 ± 4 months) compared with rituximab (17.88 ± 3.66).

Conclusion: We showed a significant improvement in the CAS, visual acuity, diplopia, and proptosis with both tocilizumab and rituximab.

Keywords: Graves’s orbitopathy; Tocilizumab; outcome; rituximab.

MeSH terms

  • Antibodies, Monoclonal, Humanized
  • Graves Ophthalmopathy* / drug therapy
  • Humans
  • Immunologic Factors / therapeutic use
  • Rituximab / therapeutic use
  • Steroids

Substances

  • Antibodies, Monoclonal, Humanized
  • Immunologic Factors
  • Steroids
  • Rituximab
  • tocilizumab