Tocilizumab Treatment for Early Active-Phase Thyroid Eye Disease

To evaluate the efficacy and safety of tocilizumab as a primary treatment and with bridge corticosteroid treatment for early active-phase thyroid eye disease (TED).

A single-center observational study was conducted among adult patients with treatment-naïve TED who initiated tocilizumab infusions (8 mg/kg administered monthly) within 9 months of developing the signs or symptoms of the disease. Primary outcomes were proptosis reduction and relapse rate. Secondary outcomes included resolution of lid edema, improvement in extraocular motility restriction, improvement in TED-associated compressive optic neuropathy, and incidence of side effects or adverse events.

Among 23 patients studied, 24 orbits from 12 patients met inclusion criteria. The mean duration of active TED at initial consultation was 3.5 months, and prior to treatment was 5.3 months. Seven patients (58%) received tocilizumab monotherapy, and 5 patients (42%) received oral prednisone bridge followed by tocilizumab infusions. An average of 6.4 tocilizumab infusions were received. Mean proptosis reduction was 3.2 mm (p < 0.001), with proptosis reduction ≥2 mm seen in 18 orbits (75%, p < 0.001). TED-associated compressive optic neuropathy was present in 7 orbits prior to treatment, and all affected orbits (100%) demonstrated improvement or resolution with treatment (p = 0.02). No statistical difference in outcome measures was found between the monotherapy and bridge therapy groups. The mean follow-up interval after completion of tocilizumab treatment was 10 months (range, 4-22; median 9). Relapse was seen in 1 patient. Tocilizumab infusions were well-tolerated, and adverse events were rare.

Tocilizumab shows promise as an effective and well-tolerated first-line treatment option as either monotherapy or following a corticosteroid bridge for early active-phase TED.