Outcomes of Intravenous Tocilizumab Treatment for Refractory Pars Planitis

ABSTRACT

Purpose

To evaluate outcomes of intravenous (IV) tocilizumab (TCZ) in patients with pars planitis refractory to conventional immunomodulatory therapy and anti-tumor necrosis factor (TNF) alpha agents.

Methods

Medical records of eight patients diagnosed with pars planitis and treated with monthly 4 or 8 mg/kg IV TCZ were reviewed. The primary objective was to initiate and sustain remission continuously for three consecutive months. Secondary outcome measures were changes in best corrected visual acuity (BCVA), degree of anterior chamber (AC) inflammation, vitreous cell, vitreous haze, presence of vitreous or pars plana exudates, peripheral vasculitis, fluorescein angiography (FA) score and central subfieldthickness (CST) on macular optical coherence tomography (OCT).

Results

Fourteen eyes of eight patients were treated with IV TCZ. Seven patients were women. The average age was 31.35 ± 16.42 years. In 6 (75%) out of 8 patients, IV TCZ, either as monotherapy or in combination with another conventional immunomodulatory agent, induced and sustained remission. The average FA score reduced from 11.15 ± 3.52 at the baseline visit to 6.50 ± 2.12 at the one-year follow-up visit (p-value < 0.05). None of the patients experienced any side effects of IV TCZ.

Conclusion

IV Tocilizumab (TCZ) may represent an effective and safe treatment option for patients diagnosed with pars planitis resistant to conventional immunomodulatory therapy and anti-TNF alpha agents.

KEYWORDS:

• Central subfield thickness
• fluorescein angiography
• macular edema
• pars planitis
• tocilizumab

Acknowledgments

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosure statement

Dr. C Stephen Foster declares the following: Consultancies with Aldeyra Therapeutics (Lexington, MA), Allakos (Redwood City, CA), Bausch & Lomb Surgical, Inc (Rancho Cucamonga, CA), Eyegate Pharma (Waltham, MA), Genentech (South San Francisco, CA), Novartis (Cambridge, MA), pSivida (Watertown, MA).

Grants or grants pending with Aciont (Salt Lake City, UT), Alcon (Aliso Viejo, CA), Aldeyra Therapeutics (Lexington, MA), Bausch & Lomb (Rochester, NY), Clearside Biomedical (Alpharetta, GA), Dompé pharmaceutical (Milan, Italy), Eyegate Pharma (Waltham, MA), Mallinckrodt pharmaceuticals (Staines-upon-Thames, UK), Novartis Pharmaceuticals (Cambridge, MA), pSivida (Watertown, MA), Santen (Osaka, Japan).

Payment for lectures including service on speaking bureaus: Alcon (Aliso Viejo, CA), Allergan (Dublin, Ireland), Mallinckrodt pharmaceuticals (Staines-upon-Thames, UK) Stock or Stock Options: Eyegate Pharma (Waltham, MA).

Dr. Stephen D. Anesi declares the following: Mallinckrodt: speaker and consultant, Eyepoint: speaker and consultant, Alimera: speaker, Bausch & Lomb: speaker and consultant, Novabay: consultant, Abbvie: speaker.

All other authors have no proprietary or commercial interest in any materials discussed in this article or additional financial disclosures to declare.

Compliance with ethics guidelines

This study was approved by the New England Institutional Review Board, which has issued a waiver of informed consent for the retrospective chart review analysis.

This study was performed in accordance with the Helsinki Declaration of 1964, and its later amendments.

All participants provided consent for publication if any identifying information is included in the manuscript.

Data availability statement

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

Statement of consent

All patients have given informed consent to participate in the research.

Additional information

Funding

This trial was supported by an investigator-initiated research grant from Mallinckrodt (Staines-upon-Thames, United Kingdom). Mallinckrodt had no role in the design or conduct of this research nor production of this manuscript.