Tocilizumab Plus Methotrexate as Effective Rescue Therapy in Dysthyroid Optic Neuropathy Relapsing after Surgical Orbital Decompression

Case Report

Volume 5, Issue 1 (January Issue)

Tocilizumab Plus Methotrexate as Effective Rescue Therapy in Dysthyroid Optic Neuropathy Relapsing after Surgical Orbital Decompression

Paolo Piero Limone^1,5*, Maurilio Deandrea¹, Claudia Lomater², Annalisa Macera³, Vittorio Ferrero⁴, Stefano Sellari Franceschini¹, Eleonora Cerutti⁵, Mario Salvi⁶ and Marco Mellano⁷

¹Department of Endocrinology and Center for Thyroid Diseases “Aurelio Costa”, Italy
²Department of Rheumathology, and Center for Thyroid Diseases “Aurelio Costa”, Italy
³Department of Radiology and Center for Thyroid Diseases “Aurelio Costa”, Italy
⁴Department of Otolaringology and Center for Thyroid Diseases “Aurelio Costa”, Italy
⁵Department of Pharmacy A.O. Ordine Mauriziano di Torino-Turin, Italy
⁶Graves' Orbitopathy Center, Endocrinology, Fondazione IRCCS Cà Granda, Milan, Italy
⁷Department of Ophtalmology and Center for Thyroid Diseases “Aurelio Costa”, Italy

^*Corresponding author: Paolo Piero Limone, Endocrinology Diabetes and Metabolism Unit, and Center for Thyroid Diseases, A.O. Ordine Mauriziano, Scientific Foundation Mauriziana Turin, Italy. E-mail: plimone@mauriziano.it

Received: December 10, 2022; Accepted: December 27, 2022; Published: January 15, 2023

Citation: Limone PP, Deandrea M, Lomater C, et al. Tocilizumab Plus Methotrexate as Effective Rescue Therapy in Dysthyroid Optic Neuropathy Relapsing after Surgical Orbital Decompression. Clin Image Case Rep J. 2023; 5(1): 292.

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Tocilizumab Plus Methotrexate as Effective Rescue Therapy in Dysthyroid Optic Neuropathy Relapsing after Surgical Orbital Decompression

Abstract

Background: The treatment of Dysthyroid Optic Neuropathy (DON) relapsing after surgical orbital decompression has not been established. Both radiotherapy and corticosteroids frequently fail. Novel immunosuppressive drugs have been used in limited series or case reports. The association of tocilizumab (TCZ), a monoclonal antibody directed against the IL-6 receptor, and methotrexate (MTX) has reasonable pharmacological and pathophysiological bases.

Material and Methods: A patient with steroid-resistant DON relapsed four weeks after three-wall orbital decompression surgery. She was treated with a combination of TCZ (8mg/kg; four administrations four weeks apart) and MTX (10mg s.c/week for 24 weeks, then 7.5mg/week for 6 weeks).

Results: A complete and long-lasting recovery of visual acuity associated to marked reduction of the thickness of extraocular muscles and followed by inactivation of orbitopathy was observed with combined immunosuppressive therapy.

Conclusions: The combination of TCZ and MTX may be an effective option for treating steroid-resistant DON.

Keywords: Graves’orbitopathy; Dysthyroid optic neuropathy; Orbital decompression; Tocilizumab; Methotrexate