Successful Tocilizumab Treatment for Scleritis

• Published in: Ocular immunology and inflammation Vol. 28; no. 2; pp. 285 - 287
• Main Authors: Poelman, Huub J., Van Daele, Paul L.A., Rothova, A
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 17.02.2020
• Subjects: Antibodies, Monoclonal, Humanized - administration & dosage; Dose-Response Relationship, Drug; Female; Giant cell arteritis; Humans; Injections, Subcutaneous; Middle Aged; Remission Induction - methods; Scleritis; Scleritis - diagnosis; Scleritis - drug therapy; Tocilizumab; Treatment Outcome; Scleritis; Tocilizumab; Giant cell arteritis
• ISSN: 0927-3948; 1744-5078
• DOI: 10.1080/09273948.2019.1617885

Purpose: To present a rare case of scleritis associated with a prior diagnosis of giant cell arteritis (GCA) that was unresponsive to glucocorticoids, nonsteroidal anti-inflammatory drugs (NSAIDs), methotrexate, and azathioprine, but reached and maintained a full remission with tocilizumab. Observations: A 62-year-old Caucasian female presented with scleritis and headache. Four years earlier, the patient was diagnosed with GCA. Treatment with topical and systemic NSAIDs, prednisone and diverse disease-modifying antirheumatic drugsonly had a partial effect on the scleritis whilst the arthralgia and headaches increased. Despite the absence of laboratory evidence of active GCA, tocilizumab was started and the scleritis and headaches disappeared within several days. Prednisone could be fully tapered within 3 months and to date, 12 months after the start of tocilizumab, the patient has maintained a sustained remission. Conclusions: Our patient demonstrates that tocilizumab might represent a therapeutic option for scleritis, and its further evaluation for this severe ocular disease is worthwhile.