By J. Fernando Arevalo, MD, FACS
This small retrospective study found that the interleukin (IL)-6 receptor antagonist tocilizumab controlled inflammation and maintained or improved visual acuity in refractive uveitis-related macular edema while patients were receiving this treatment.
Tocilizumab is a fully humanized antibody that binds both to soluble and membrane-bound IL-6 receptors and is approved for the treatment of rheumatoid arthritis refractory to one or more anti-tumor necrosis factor α drugs.
This study is important because these results suggest that IL-6 may play an important pathogenic role in the perpetuation of chronic macular edema associated with uveitis. Although further studies are necessary, IL-6 may be considered a novel target for refractory uveitis and associated macular edema.
The study included seven patients (11 eyes) with refractory uveitis-related macular edema treated with tocilizumab at one tertiary referral center. The mean duration of macular edema was 14.2 years, and mean treatment with tocilizumab therapy during the study was 15.2 months (range, 12 to 18 months).
Before tocilizumab therapy, conventional immunosuppressive therapy and one or more biologic agents failed in all patients. Uveitis diagnoses were birdshot chorioretinopathy (n = 3), juvenile idiopathic arthritis-associated uveitis (n = 3) and idiopathic panuveitis (n = 1).
At one year follow-up, mean central foveal thickness was significantly reduced and mean BCVA significantly improved.
Tocilizumab therapy was discontinued in two patients because of sustained remission at month 12. However, in both patients, macular edema relapsed three months later. Reinitiation of tocilizumab therapy led to good uveitis control and macular edema resolution.
Tocilizumab generally was well tolerated with no serious adverse events. However, the long-term adverse effects of tocilizumab therapy remain unknown.
Question: Chronic macular edema associated with uveitis may have the following characteristics:
a. Anterior uveitis, vitritis, retinal vasculitis, retinochoroiditis
b. Is uncommon in uveitis
c. May be related to IL-6 and treated with tocilizumab
d. Have good prognosis
e. All of the above
Answer: C