Efficacy of Anti-IL6-Receptor Tocilizumab in Refractory Cystoid Macular Edema of Birdshot Retinochoroidopathy Report of Two Cases and Literature Review

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.

Keywords:

• Birdshot retinochoroidopathy
• tocilizumab

DECLARATION OF INTEREST

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Disclosures: Dr MA González-Gay received grants/research supports from Abbott, MSD and Roche, and had consultation fees/participation in company sponsored speaker’s bureau from Abbott, Pfizer, Roche, Jansen, Lilly, and MSD. Dr R Blanco received grants/research supports from Abbott, MSD, and Roche, and had consultation fees/participation in company sponsored speaker’s bureau from Abbott, Pfizer, Roche, Bristol-Myers, Janssen, and MSD.

Vanesa Calvo-Río, Montserrat Santos-Gómez, David Díaz-Valle, Esperanza Pato, Javier Loricera, MC González-Vela, Rosalía Demetrio Pablo and JL Hernández have no financial disclosures to declare.

FUNDING

This work was partially supported by RETICS Programs, RD08/0075 (RIER) and RD12/0009/0013 from the “Instituto de Salud Carlos III” (ISCIII) (Spain).

Additional information

Funding

This work was partially supported by RETICS Programs, RD08/0075 (RIER) and RD12/0009/0013 from the “Instituto de Salud Carlos III” (ISCIII) (Spain).