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This prospective European study looks at the response to tocilizumab in corticosteroid-resistant disease. Tocilizumab (TCZ) is a monoclonal antibody that competitively inhibits IL-6 binding to its receptor. Unlike teprotumumab, the advantage of TCZ is that it is already used within the NHS and other healthcare systems and has a lower financial burden. The number of study participants is small (n=10), however the authors state that TCZ resulted in a mean clinical activity score (CAS) reduction of 4.5 ± 1.2 and also resulted in a significant decrease in thyroid-stimulating immunoglobulin. One patient with sight threatening Graves’ orbitopathy (GO) did require orbital decompression, but the authors comment that in retrospect they may have been able to delay the decision to operate until the second infusion of TCZ. There are a number of steroid-sparing agents under investigation for the treatment of GO. Given that IL-6 plays an important role in activating orbital fibroblasts, a treatment specifically targeting this pathway seems logical. Whether it proves beneficial in practice, only time will tell.

Treatment of corticosteroid-resistant Graves’ orbitopathy with tocilizumab: a single-centre prospective study.
Dorado Cortez O, Grivet D, Perrillat N, et al.
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Hetvi Bhatt

Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.

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