Utility of tocilizumab in autoimmune eye diseases

ABSTRACT

Introduction

Autoimmune eye diseases (AED) are inflammatory eye conditions caused by dysregulation of the immune system at the ocular level. Among them, the most representative is noninfectious uveitis, which can be limited to the eye or associated with various systemic autoimmune diseases. Other conditions include peripheral ulcerative keratitis, Graves’ orbitopathy, and some forms of optic neuropathy. Glucocorticoids are the cornerstone of treatment for most AEDs. However, conventional and/or biologic immunosuppressive drugs are often required to achieve clinical remission and reduce adverse events related to long-term glucocorticoid therapy.

Areas covered

To summarize all the available evidence on the use of the anti-interleukin-6 tocilizumab receptor (TCZ) for the different AEDs.

Expert opinion

The heterogeneity of the reported studies and the relatively small number of prospective randomized clinical trials make it difficult to establish robust guidelines on the positioning of TCZ in the treatment of AEDs. However, based on our own experience and the growing number of published studies, we are in favor of the use of TCZ as an effective and safe alternative for patients with severe and/or refractory AEDs. We highlight the efficacy of TCZ in patients with optic neuropathy related to giant cell arteritis, noninfectious uveitis, and Graves´ orbitopathy.

KEYWORDS:

• Autoimmune eye diseases
• noninfectious uveitis
• peripheral ulcerative keratitis
• Graves’ orbitopathy
• optic neuropathy
• neuromyelitis optica spectrum disorders
• anti-IL6-receptor antibodies
• tocilizumab

Article highlights

• Glucocorticoids and conventional immunosuppressive drugs are the standard therapy for most autoimmune eye diseases.

• However, there are severe and/or refractory patients who need an alternative therapeutic option. Moreover, some patients do not tolerate conventional therapies.

• Interleukin-6 plays a major role in the pathogenesis of autoimmune eye diseases. The humanized monoclonal antibody inhibitor of interleukin-6 receptor, tocilizumab, has demonstrated efficacy in different ocular conditions.

• The available evidence supports the use of tocilizumab, regardless of the route of administration, in diverse highly refractory autoimmune eye diseases, especially in non-infectious uveitis, Graves’ orbitopathy and optic neuropathy related to giant cell arteritis.

• Additionally, there is proven efficacy of tocilizumab in patients with severe and refractory peripheral ulcerative keratitis or neuromyelitis optica spectrum disorders.

• Nevertheless, more prospective and randomized studies are needed in order to standardize the use of tocilizumab in these ocular pathologies. We propose potential indications of this agent for diverse autoimmune eye diseases.

Declaration of interest

B Atienza-Mateo has received grants/research supports from AbbVie and Roche, and consultation fees/participated in company-sponsored speaker’s bureaus from Pfizer, Celgene, Novartis, Sanofi, Janssen, Union Chimique Belge Pharma and Eli Lilly.

D Prieto-Peña is supported by a research contract from the Carlos III Health Institute of Spain (Río Hortega program, ref. CM20/00006) and has received grants/research supports from Union Chimique Belge Pharma, Roche, Sanofi, Pfizer, AbbVie, Eli Lilly and the Spanish Foundation of Rheumatology (FER-GALAPAGOS program).

EF Vicente-Rabaneda has received consultation fees/participated in company sponsored speaker´s bureau from AbbVie, Amgen, Bristol-Myers Squibb, Eli Lilly, Merck Sharp & Dohme, Pfizer, Roche and Union Chimique Belge Pharma.

R Blanco has received grant/research support from Abbvie and Roche and company-sponsored speaker´s bureau fees from AbbVie, Amgen, Bristol-Myers Squibb, Galapagos, Janssen, Lilly, Merck Sharp & Dohme, Novartis, Pfizer, Roche and Sanofi.

MA González-Gay has received grants/research support from AbbVie, Merck Sharp & Dohme, Janssen and Roche and has received consultation fees/participated in company-sponsored speakers bureaus tied to AbbVie, Pfizer, Roche, Sanofi, Eli Lilly, Celgene, Merck Sharp & Dohme and GlaxoSmithKline.

S Castañeda has received grants/research support from Amgen, Merck Sharp & Dohme and Pfizer, and has received consultation fees in company sponsored speaker’s bureaus from Amgen, Bristol-Myers Squibb, Grünenthal Pharma, Janssen, Lilly, Merck Sharp & Dohme, Novartis, Sanofi, Swedish Orphan Biovitrum (Sobi) SL, Stata and Union Chimique Belge. S Castañeda is also associated professor of the UAM-Roche chair, EPID-Future, Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.