Shu Wenjun, Yan Mingxu, Gan Lu, Li Lu, Tao Hongyue, Peng Zhiyu, Wang Jinghan, Li Xiaofeng, Lin Xintong, Chen Haifeng, Guo Jie, Xue Kang, Cui Hongguang, Lou Heng, Xu Binbin, Cheng Jinwei, Ye Hongying, Li Yiming, Qian Jiang, Zhang Rui, Ma Ruiqi, Zeng Fangfang
Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.
NHC Key Laboratory of Myopia and Related Eye Diseases; Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China.
Front Immunol. 2025 May 29;16:1556742. doi: 10.3389/fimmu.2025.1556742. eCollection 2025.
Tocilizumab (TCZ) has been demonstrated to be effective in treating thyroid-associated ophthalmopathy (TAO); however, its efficacy in hormone-resistant dysthyroid optic neuropathy (DON) remains unclear. This study aims to identify baseline and post-treatment indicators that can predict the necessity for surgical intervention following TCZ therapy.
Thirty-one hormone-resistant DON patients treated with TCZ were categorized into surgery (n=15, 7 males, 8 females) and non-surgery (n=16, 8 males, 8 females) groups based on their post-TCZ surgical status. Retrospective comparisons between the two groups were performed using pre- and post-treatment ophthalmic assessments, biomarkers, and orbital magnetic resonance imaging (MRI) scans. The predictive value of identified variables was evaluated through receiver operating characteristic (ROC) curve analysis and logistic regression analysis.
The surgery group exhibited a significantly higher baseline thyroid-stimulating hormone receptor antibody (TRAb) (=0.001) and a positive change in the maximal signal intensity ratio of extraocular muscle to temporalis muscle (SIR(EOM/temporalis)), whereas the non-surgery group demonstrated a negative change (<0.001). A TRAb cut-off value of ≤5.07 IU/L predicted non-surgery with 93.3% sensitivity and 81.2% specificity, while a SIR(EOM/temporalis) cut-off value of ≤-1.83 had 86.7% sensitivity and 87.5% specificity. The area under the curve was 0.846 for TRAb and 0.863 for SIR(EOM/temporalis). Multivariate regression confirmed SIR(EOM/temporalis) change (=0.017) as an independent predictor of surgical intervention. Linear regression revealed a significant correlation between SIR(EOM/temporalis) change and TCZ dosage in the non-surgery group (=0.005), but not in the surgery group.
The percentage change in SIR(EOM/temporalis) following TCZ treatment and baseline TRAb can serve as predictors of the necessity for surgical intervention in hormone-resistant DON. These indicators assist in the personalization of TCZ therapy and in the avoidance of unnecessary surgical procedures.
托珠单抗（TCZ）已被证明对治疗甲状腺相关眼病（TAO）有效；然而，其在激素抵抗性甲状腺功能障碍性视神经病变（DON）中的疗效仍不清楚。本研究旨在确定能够预测TCZ治疗后手术干预必要性的基线指标和治疗后指标。
31例接受TCZ治疗的激素抵抗性DON患者根据TCZ治疗后的手术状态分为手术组（n = 15，男性7例，女性8例）和非手术组（n = 16，男性8例，女性8例）。使用治疗前和治疗后的眼科评估、生物标志物和眼眶磁共振成像（MRI）扫描对两组进行回顾性比较。通过受试者工作特征（ROC）曲线分析和逻辑回归分析评估所确定变量的预测价值。
手术组的基线促甲状腺激素受体抗体（TRAb）显著更高（=0.001），眼外肌与颞肌的最大信号强度比（SIR（EOM/颞肌））呈正向变化，而非手术组呈负向变化（<0.001）。TRAb临界值≤5.07 IU/L预测非手术的灵敏度为93.3%，特异度为81.2%，而SIR（EOM/颞肌）临界值≤ -1.83的灵敏度为86.7%，特异度为87.5%。TRAb的曲线下面积为0.846，SIR（EOM/颞肌）的曲线下面积为0.863。多变量回归证实SIR（EOM/颞肌）变化（=0.017）是手术干预的独立预测因素。线性回归显示非手术组中SIR（EOM/颞肌）变化与TCZ剂量之间存在显著相关性（=0.005），而手术组中则不存在。
TCZ治疗后SIR（EOM/颞肌）的百分比变化和基线TRAb可作为激素抵抗性DON手术干预必要性的预测指标。这些指标有助于TCZ治疗的个体化，并避免不必要的手术程序。
