Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy.
Institute for Maternal and Child Health "IRCCS Burlo Garofolo", Trieste, Italy.
Pediatr Rheumatol Online J. 2023 Sep 12;21(1):99. doi: 10.1186/s12969-023-00883-y.
Tocilizumab is a humanized monoclonal antibody that acts as an IL-6 receptor antagonist. Intravenous tocilizumab is considered an option for children with anti-TNF refractory juvenile idiopathic arthritis-associated uveitis. In contrast, the potential of subcutaneous drug use with this indication is more controversial. Due to the decreased availability of intravenous tocilizumab during the COVID-19 pandemic, we started using the subcutaneous formulation of the drug in children with anti-TNF refractory uveitis. The study analyzes the serum concentration of tocilizumab and its clinical response in patients with anti-TNF refractory uveitis who started or switched to subcutaneous administration from intravenous use.
Five patients with non-infectious uveitis were treated with subcutaneous tocilizumab. Ocular inflammation was evaluated on slit lamp examination during clinical control. Serum tocilizumab concentrations were determined by ELISA.
The mean blood concentration of tocilizumab was 61.4 µg/mL (range 2.7-137.0.), with higher values than levels recorded in adult patients with rheumatoid arthritis treated with intravenous tocilizumab. Three patients entered clinical remission. One patient developed a mild relapse and was treated with topical steroids. Only one patient did not respond to therapy. The medication was well tolerated without severe infection or other adverse events.
Our results support a possible role of subcutaneous tocilizumab in anti-TNF refractory uveitis.
托珠单抗是一种人源化单克隆抗体，作为 IL-6 受体拮抗剂。静脉注射托珠单抗被认为是对 TNF 拮抗剂难治性幼年特发性关节炎相关葡萄膜炎患儿的一种选择。相比之下，该适应证皮下用药的潜力更具争议性。由于 COVID-19 大流行期间静脉注射托珠单抗的供应减少，我们开始在对 TNF 拮抗剂难治性葡萄膜炎的儿童中使用该药的皮下制剂。本研究分析了开始或从静脉用转换为皮下用的对 TNF 拮抗剂难治性葡萄膜炎患者的托珠单抗血清浓度及其临床反应。
5 例非感染性葡萄膜炎患者接受了皮下托珠单抗治疗。在临床控制时通过裂隙灯检查评估眼部炎症。通过 ELISA 测定托珠单抗的血清浓度。
托珠单抗的平均血药浓度为 61.4 µg/mL（范围 2.7-137.0），高于静脉注射托珠单抗治疗的类风湿关节炎成年患者的水平。3 例患者进入临床缓解期。1 例患者出现轻度复发，给予局部皮质类固醇治疗。只有 1 例患者对治疗无反应。药物耐受性良好，无严重感染或其他不良反应。
我们的结果支持皮下托珠单抗在 TNF 拮抗剂难治性葡萄膜炎中的可能作用。
