Purpose

We aimed to compare the efficacy and safety of intravenous tocilizumab versus subcutaneous sarilumab as first-line treatment in patients with Graves’ orbitopathy (GO) with low clinical activity scores (CAS 1–3) and impaired quality of life.

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Methods

We performed a retrospective longitudinal study of patients diagnosed with GO and a EUGOGO clinical activity score (CAS) of 1–3 out of 10 who were treated with tocilizumab or sarilumab as first-line, at a single centre, Centro Oftalmológico Moreiras. Patients were included between January 2019 and January 2024. The main primary outcomes were reductions in CAS and thyroid-stimulating immunoglobulin (TSI) blood levels. The GO-QOL questionnaire was used to assess quality-of-life impairment.

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Results

Sixty-six patients received intravenous tocilizumab (mean age 50.4, 78.8% were female), and 62 patients received subcutaneous sarilumab (mean age of 44.23 years and 80.6% female). The mean number of tocilizumab infusions was 4.47, compared with 3.42 sarilumab sessions (p = 0.05). In both groups, 100% of patients achieved disease inactivation (CAS 0 or 1) and TSI normalization (≤10 IU/L) at the end of treatment. The relapse rate was 9.1% in the tocilizumab group versus 4.84% in the sarilumab group (p = 0.07). Mild to moderate transient adverse events were observed in both groups (63.6% vs. 67% respectively), but no major adverse events were reported in either group.

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Conclusion

Our findings suggest that both tocilizumab and sarilumab are effective and safe options for the first-line treatment of GO with low CAS. Our results also suggest that patients treated with sarilumab achieved disease inactivation with fewer treatment sessions and register fewer relapses during follow-up.

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Additional Authors

First name	Last name	Base Hospital / Institution
Carlos	Fdez-Veja	Centro Oftalmológico Moreiras
Dolores	Abelenda	Centro Oftalmológico Moreiras
Guilherme	Castela	ULS Coimbra
José	Pérez-Moreiras	Centro Oftalmológico Moreiras

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