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Klin Monbl Augenheilkd 2025; 242(12): 1200-1210
DOI: 10.1055/a-2737-3576
Klinische Studie

Assessing the Role of Tocilizumab in the Treatment of Thyroid Eye Disease: A Retrospective Single Centre Analysis

Article in several languages: English | deutsch

Authors

  • Inga Neumann

    1   Augenklinik, Universität Duisburg-Essen, Universitätsmedizin Essen, Deutschland

  • Ying Chen

    1   Augenklinik, Universität Duisburg-Essen, Universitätsmedizin Essen, Deutschland

  • Dagmar Fuehrer-Sakel

    2   Klinik für Endokrinologie, Diabetologie und Stoffwechsel, Universität Duisburg-Essen, Duisburg, Deutschland

  • Michael Oeverhaus

    1   Augenklinik, Universität Duisburg-Essen, Universitätsmedizin Essen, Deutschland

  • Julia Messner

    2   Klinik für Endokrinologie, Diabetologie und Stoffwechsel, Universität Duisburg-Essen, Duisburg, Deutschland

  • Sera Sarim

    3   Augenklinik, Evangelische Krankenhaus Essen-Werden, Essen, Deutschland

  • Anja Eckstein

    1   Augenklinik, Universität Duisburg-Essen, Universitätsmedizin Essen, Deutschland
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Abstract

Background Due to the variable course of thyroid eye disease (TED), treatment should be tailored to disease severity, individual risk factors, and clinical course. This study is based on a retrospective analysis at the orbital centre of the University Eye Clinic Essen and evaluates the efficacy of the IL-6 receptor blocker tocilizumab as a second-line therapy in patients with therapy-refractory TED.

Patients/Methods After approval of cost coverage, 20 patients were treated with tocilizumab over a mean period of 4.8 ± 2.7 months. The following parameters were assessed: sex, age, underlying thyroid disease, disease activity and severity, prior therapies, visual acuity, intraocular pressure, eyelid position, exophthalmos, monocular excursions, strabismus/diplopia, levels of TSH receptor antibodies (TRAb), and adverse events.

Results The female-to-male ratio was 3 : 1. Mean patient age was 58.2 ± 8.5 years. The majority (90%, n = 18) had Gravesʼ disease; one patient had primary hypothyroidism and one was euthyroid. All patients had previously failed various treatment regimens (median cumulative steroid dose 4.6 g [1.5 – 7.5 g], 55% mycophenolate, 65% orbital apex radiation, 20% balanced orbital decompression). Among 17 patients with detectable TRAb at baseline, mean antibody levels decreased by 48.4%. A reduction of at least 30% was achieved in 70.6% of these patients (n = 17). A decrease in the Clinical Activity Score (CAS) by ≥ 2 points was observed in 70% of cases. The mean inflammation score (maximum 20 points per patient) decreased from 8.8 ± 3.9 to 3.4 ± 2.4. The effect on exophthalmos was moderate: mean reduction was 0.9 ± 1.8 mm (range − 6 mm to + 3 mm). A decrease of ≥ 2 mm was documented in 25% of patients, whereas an increase was noted in 12.5% (0.5 to 3 mm). Improvement in ocular motility was documented in 22.5% of patients, while 10% showed deterioration.

Discussion This cohort exclusively included therapy-refractory patients, some with protracted disease. The significant reduction in inflammation and particularly in TRAb levels, as a biomarker of disease activity, demonstrate the efficacy of tocilizumab in this highly selected population. Tocilizumab may therefore be an important treatment option for patients with high antibody levels and predominantly inflammatory disease manifestations. Further studies are warranted to evaluate whether it reduces the risk of relapse after successful treatment with an IGF-1 receptor blocker.

Keywords

Orbit - thyroid eye disease - teprotumomab - proptosis


Publication History

Received: 15 July 2025

Accepted: 28 October 2025

Accepted Manuscript online:
03 November 2025

Article published online:
12 December 2025

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