Comparative Effectiveness of Intravenous versus Subcutaneous Tocilizumab for Refractory Uveitis: A Retrospective Analysis

Abstract

Purpose: To compare the efficacy and safety of IV and subcutaneous tocilizumab in the treatment of noninfectious intermediate uveitis, posterior uveitis, and panuveitis.

Design: Multicenter, retrospective, observational study.

Participants: Adult patients with noninfectious uveitis treated with tocilizumab.

Methods: Patients received IV tocilizumab (8 mg/kg every 4 weeks; n = 66) or subcutaneous tocilizumab (162 mg/week; n = 70). The decision to introduce tocilizumab and the administration route were left to the discretion of the clinician.

Main outcome measures: The primary outcome was resolution of macular edema at 6 months. Secondary outcomes were proportion of patients with treatment success and inactive disease, best-corrected visual acuity (BCVA) change from baseline, corticosteroid-sparing effect, and adverse events.

Results: One hundred thirty-six patients (42% men; median age, 51 years [interquartile range, 41-65 years]) were included. Patients in the IV tocilizumab group showed more severe disease, that is, they experienced more frequent macular edema, showed worse initial BCVA, and demonstrated more frequent previous anti-tumor necrosis factor α failure. A significantly higher proportion of patients receiving IV tocilizumab achieved resolution of macular edema at 6 months compared to subcutaneous tocilizumab group (odds ratio, 3.96; 95% confidence interval [CI], 1.3-12.92; P = 0.01). The difference was not significant after 12 months of treatment (odds ratio, 2.46; 95% CI, 0.30-30.18; P = 0.40). The gain in visual acuity after 12 months of treatment was higher in the IV tocilizumab group, with a 0.19 logarithm of the minimum angle of resolution gain of BCVA, compared with the subcutaneous tocilizumab group (P = 0.02). At 12 months, 63% of patients in the IV tocilizumab group and 58% of patients in the subcutaneous tocilizumab group (P = 0.80) had inactive disease and 71% of patients in both groups achieved treatment success (P = 0.99). A total of 36 patients (26%) experienced at least 1 adverse event: 15 patients (23%) in the IV tocilizumab group and 21 patients (30%) in the subcutaneous tocilizumab group.

Conclusions: Although interpretation of the data are limited by their retrospective nature, these data suggest that IV tocilizumab may result in faster resolution of uveitic macular edema than subcutaneous tocilizumab.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Keywords: IV tocilizumab; Macular edema; Subcutaneous tocilizumab; Uveitis; Visual acuity.