Intravenous better than subcutaneous tocilizumab for noninfectious uveitis

In the treatment of noninfectious uveitis, the use of intravenous tocilizumab results in more rapid resolution of macular edema as compared with the subcutaneous formulation, according to an observational study.

The study included 136 adult patients (median age 51 years, 42 percent male) with noninfectious uveitis. Of these, 66 patients received intravenous tocilizumab at 8 mg/kg every 4 weeks, while 70 received subcutaneous tocilizumab 162 mg per week.

The primary outcome was resolution of macular edema at 6 months. Secondary outcomes included the percentage of patients with treatment success and inactive disease, best-corrected visual acuity (BCVA) change from baseline, corticosteroid-sparing effect, and adverse events.

Patients in the intravenous vs subcutaneous tocilizumab group were more likely to have frequent macular edema, worse initial BCVA, and a prior antitumour necrosis factor α treatment failure.

At 6 months, significantly more patients receiving intravenous tocilizumab achieved resolution of macular edema compared with those receiving subcutaneous tocilizumab (odds ratio, 3.96, 95 percent confidence interval [CI], 1.3–12.92; p=0.01). This difference disappeared after 12 months of treatment (odds ratio, 2.46, 95 percent CI, 0.30–30.18; p=0.40).

Visual acuity gain after 12 months of treatment was greater with intravenous tocilizumab, with a 0.19 logarithm of the minimum angle of resolution gain of BCVA, compared with the subcutaneous tocilizumab group (p=0.02).

At 12 months, 63 percent of patients in the intravenous group vs 58 percent in the subcutaneous group had inactive disease (p=0.80), and 71 percent of patients in both groups achieved treatment success (p=0.99).

Adverse events occurred in 23 percent of patients in the intravenous group and 30 percent in the subcutaneous group.