托珠单抗治疗甲状腺相关眼病。
Tocilizumab for the Management of Thyroid-Associated Orbitopathy.
机构信息
The Pacific Center for Oculofacial and Aesthetic Plastic Surgery, San Francisco, California, U.S.A.
California Pacific Medical Center, San Francisco, California, U.S.A.
出版信息
Ophthalmic Plast Reconstr Surg. 2022;38(2):188-192. doi: 10.1097/IOP.0000000000002027.
PURPOSE
To describe the efficacy of tocilizumab in the treatment of a cohort of patients with active thyroid-associated orbitopathy.
METHODS
Patients were identified with active thyroid-associated orbitopathy who were intolerant of or had progression of disease despite systemic corticosteroids and subsequently were treated with tocilizumab between January 2015 and December 2020. Clinical Activity Score, Thyroid-Associated Ophthalmopathy Scale score, and thyroid-stimulating immunoglobulin levels were assessed prior to initiation of tocilizumab, following the first dose, and after the completion of treatment.
RESULTS
Eleven patients were candidates for and underwent treatment with tocilizumab, 9 of which met criteria for analysis. Average age was 55.6 years. Average time between onset of active thyroid-associated orbitopathy and completion of tocilizumab was 6.5 months. Average number of infusions was 4.2. There was a statistically significant reduction in Clinical Activity Score, Thyroid-Associated Ophthalmopathy Scale score, and thyroid-stimulating immunoglobulin levels when comparing pre-treatment values (mean Clinical Activity Score 6.78 ± 1.09, mean Thyroid-Associated Ophthalmopathy Scale score 10.2 ± 1.92, mean thyroid-stimulating immunoglobulin level 440.6 [%]) to values immediately following completion of treatment (mean Clinical Activity Score 0.44 ± 0.53, mean difference 6.3 points, p < 0.001 [95% CI, 5.5-7.2]; mean Thyroid-Associated Ophthalmopathy Scale score 1.2 ± 1.09, mean difference 9.0 points, p < 0.001 [95% CI, 7.2-10.8]; mean thyroid-stimulating immunoglobulin level 200.7 [%], mean difference 239.9 [%], p = 0.001 [95% CI, 124.3-355.4]). One patient had elevation of cholesterol following therapy induction. Patients were followed for an average of 23.6 months after treatment. No patients had recurrence of active disease after completion of tocilizumab.
CONCLUSIONS
This study supports the use of tocilizumab as a therapy for the inflammatory phase of thyroid-associated orbitopathy.
目的
描述托珠单抗治疗活动期甲状腺相关眼病患者的疗效。
方法
2015 年 1 月至 2020 年 12 月期间，我们筛选出对全身皮质类固醇不耐受或疾病进展的活动期甲状腺相关眼病患者，并随后用托珠单抗进行治疗。在开始托珠单抗治疗前、首次剂量后以及治疗完成后，评估临床活动评分、甲状腺相关眼病量表评分和甲状腺刺激免疫球蛋白水平。
结果
11 名患者适合并接受了托珠单抗治疗，其中 9 名符合分析标准。平均年龄为 55.6 岁。从活动期甲状腺相关眼病发病到完成托珠单抗治疗的平均时间为 6.5 个月。平均输注次数为 4.2 次。与治疗前（平均临床活动评分 6.78±1.09，平均甲状腺相关眼病量表评分 10.2±1.92，平均甲状腺刺激免疫球蛋白水平 440.6%）相比，治疗后（平均临床活动评分 0.44±0.53，平均差异 6.3 分，p<0.001[95%CI，5.5-7.2]；平均甲状腺相关眼病量表评分 1.2±1.09，平均差异 9.0 分，p<0.001[95%CI，7.2-10.8]；平均甲状腺刺激免疫球蛋白水平 200.7%，平均差异 239.9%，p=0.001[95%CI，124.3-355.4]）时，临床活动评分、甲状腺相关眼病量表评分和甲状腺刺激免疫球蛋白水平均有显著降低。1 例患者在治疗诱导后胆固醇升高。患者在治疗后平均随访 23.6 个月。在完成托珠单抗治疗后，没有患者出现活动期疾病复发。
结论
本研究支持将托珠单抗作为甲状腺相关眼病炎症期的治疗方法。
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