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Novel treatment (new drug/intervention; established drug/procedure in new situation)
Case report
Rapid visual recovery following intravenous tocilizumab in glucocorticoid resistant refractory giant cell arteritis
  1. Carl Richard Svasti-Salee1,
  2. Susan P Mollan2,
  3. Ann W Morgan3,4 and
  4. Vanessa Quick5
  1. 1 Ophthalmology, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
  2. 2 Neuro-Ophthalmology Unit, Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  3. 3 Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
  4. 4 NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  5. 5 Rheumatology, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
  1. Correspondence to Dr Carl Richard Svasti-Salee, carl.svasti-salee{at}nhs.net

Abstract

A 72-year-old man presented with a short history of headache, jaw claudication, double vision, amaurosis fugax and distended temporal arteries. A diagnosis of giant cell arteritis (GCA) was confirmed on temporal artery ultrasound and temporal artery biopsy. Despite treatment with high-dose oral glucocorticoid (GC) and multiple pulses of intravenous methylprednisolone, his vision deteriorated to hand movements in one eye. 8 mg/kg intravenous tocilizumab, a humanised, recombinant anti-IL-6 receptor antibody, was administered within 48 hours of vision loss and continued monthly, resulting in marked visual improvement within days, as well as sustained remission of GCA. This case suggests a possible role for tocilizumab as a rescue therapy to prevent or recover visual loss in patients with GCA resistant to GC treatment, termed refractory GCA. Further research is required to elucidate the role of intravenous administration of tocilizumab in this setting.

  • Ophthalmology
  • Rheumatology

https://doi.org/10.1136/bcr-2019-229236

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    Footnotes

    • Contributors CRS-S and VQ conceived and drafted the case report and were directly involved in the patient’s care. VQ provided the temporal artery ultrasound images and their analysis. SPM and AWM contributed substantially to the report and its critical review. SPM also provided analysis of the OCT data.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests SPM received speaker and advisory board fees from Roche and Chugai outside of the submitted work. AWM reports grants from the Medical Research Council during the conduct of the submitted work, and received consultancy fees from Sanofi and Chugai and non-financial support from Roche outside of the submitted work. VQ received consultancy fees from Roche and carried out unpaid consultancy work for Sanofi outside of the submitted work.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Obtained.