Abstract Listings 2024

Purpose

To evaluate the clinical outcomes of intravenous tocilizumab (TCZ) infusions in thyroid eye disease (TED) patients with dysthyroid optic neuropathy (DON).

Methods

Patients with DON who did not respond to standard therapies such as intravenous methylprednisolone, radiotherapy, mycophenolate and decompression surgery were treated with TCZ from September 2019 to December 2023. The medical records of patients identified were reviewed after completion of TCZ infusions. Patient demographics, including the duration of TED, smoking status, visual acuity, clinical activity score (CAS) before treatment and after the last TCZ infusion were analysed. Thyroid stimulating hormone receptor antibodies (TRAb) were also evaluated. Assessment was performed on subjective symptoms reported with the thyroid eye disease quality of life (TED QOL) questionnaire before and after completion of treatment.

Results

3 TED patients (4 eyes) with DON whom had poor response to standard therapies were identified to have completed TCZ treatment with a mean of 4.67 ±1.07 infusions. Mean follow up duration was 774 ±483.36 days. There were no reported significant side effects, other than mild headache in 1 patient. Clinical symptoms before and after completion of treatment showed decrease in mean CAS of 5.33 ±1.07 points. Visual acuity improved in 2 eyes and remained stable in the other 2 eyes. Improvement in proptosis on Hertel exophthalmometry was 3.67 ±0.75 mm. A reduction in mean TRAb by 11.96 ±14.32 IU/L was found upon completion of TCZ infusions. There was a decrease in mean TED QOL scores recorded of 11 ±8.32 points after treatment.

Conclusion

Tocilizumab can be efficacious in treating thyroid eye disease patients with dysthyroid optic neuropathy, showing good drug safety profile and reasonable response to inflammation with improvement in disease related quality of life, where standard therapies have failed.

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