Tocilizumab in glucocorticoid-resistant graves orbitopathy. A case series report of a mexican population

PurposeTo describe pre- to post-treatment changes in clinical activity score (CAS) and exophthalmometry in patients with Graves orbitopathy treated with tocilizumab (TCZ).Material and methodsEight Mexican patients presenting with active Graves orbitopathy (CAS > 3/7) previously treated with glucocorticoids received 1 monthly dose of TCZ for 6 months. CAS, EUGOGO severity assessment and exophthalmometry were used to evaluate clinical status, with serum measurement of thyroid-stimulating hormone receptor antibodies (TR-Ab) for biochemical evaluation before and after application of TCZ.ResultsEight patients were analyzed: 6 male (75%), 2 female (25%): mean age, 45.9 ± 11.2 years; mean weight, 85 ± 18.3 kg. Mean TR-Ab level at treatment outset was 291.9 ± 96.4%, mean CAS 4.1 ± 0.3 and mean exophthalmometry 21.2 ± 3.2 mm. After TCZ treatment, mean TR-Ab level fell to 172.7 ± 54% (P = 0.001), mean CAS to 1.1 ± 0.6 (P = 0.001) and mean exophthalmometry to 19.3 ± 2 mm (P = 0.02).ConclusionsTCZ is a therapeutic option for glucocorticoid-resistant orbitopathy, and should be considered in second line due to the cost of treatment or in first line in patients with contraindications to intravenous GC pulse therapy.