Tocilizumab

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Article initiated by:
Jainam Shah, Jason Zheng, Sachin Pathuri, Andrew Go Lee, MD, Bruce Becker, MD
All contributors:
Jainam Shah, Jason Zheng, Sachin Pathuri, Andrew Go Lee, MD, Bruce Becker, MD
Assigned editor:
Review:
Assigned status Update Pending
.


This article reviews the mechanism of action, FDA-approved indications, and safety profile of tocilizumab, with particular emphasis on its emerging role in ophthalmology. It summarizes current evidence supporting IL-6 receptor blockade in thyroid eye disease and uveitic macular edema, including dosing strategies, clinical outcomes, and reported adverse events. Comparative considerations between intravenous and subcutaneous formulations are discussed, along with cost implications and practical considerations for clinical use. Areas requiring further investigation, including optimal dosing and long-term safety in ophthalmic populations, are also highlighted.

Background

Tocilizumab (TCZ) is a humanized monoclonal antibody that antagonizes both soluble and membrane-bound interleukin-6 receptors (sIL-6R and mIL-6R).[1] TCZ was developed through collaboration between Chugai Pharmaceutical and Roche, with initial Food and Drug Administration (FDA) approval in the United States occurring in 2010 for rheumatoid arthritis.[2] Tocilizumab is marketed under four FDA-approved brand names in the United States: Actemra (the original brand), Avtozma, Tofidence, and Tyenne.

Although originally approved for systemic inflammatory conditions, TCZ has increasing relevance in ophthalmology. Interleukin-6 (IL-6) is a key proinflammatory cytokine implicated in ocular inflammatory diseases, including giant cell arteritis–associated vision loss, thyroid eye disease, noninfectious uveitis, and uveitic macular edema. IL-6 contributes to T-cell differentiation, B-cell activation, vascular permeability, and breakdown of the blood–retinal barrier, all of which are central to the pathogenesis of ocular inflammation. As a result, IL-6 receptor blockade has emerged as a targeted therapeutic strategy in several vision-threatening inflammatory conditions.

FDA-Approved Indications for Tocilizumab and Biosimilars

TCZ and its FDA-approved biosimilars share overlapping but not identical labeled indications. They are highly similar in mechanism, safety, and efficacy, with minor variations in their labeled indications due to patent protections or timing of approval.

Indication Actemra[1] Avtozma[3] Tofidence[4] Tyenne[5]
Rheumatoid arthritis (RA) ✓ ✓ ✓ ✓
Giant cell arteritis (GCA) ✓ ✓ ✓ ✓
Polyarticular juvenile idiopathic arthritis (PJIA) ✓ ✓ ✓ ✓
Systemic juvenile idiopathic arthritis (SJIA) ✓ ✓ ✓ ✓
Systemic sclerosis–associated interstitial lung disease (SSc-ILD) ✓ — — —
Cytokine release syndrome (CRS) ✓ ✓ — ✓
SARS-CoV-2 (COVID-19) ✓ ✓ ✓ ✓

FDA-Approved Administration and Dosing

FDA-approved administration routes and dosing regimens for TCZ and its biosimilars are shown below. They vary by indication and route of administration; in several populations, dosing is determined by patient body weight as specified in FDA labeling.

Condition Intravenous (IV) Subcutaneous (SC)
RA 4 mg/kg every 4 weeks; may increase to 8 mg/kg every 4 weeks based on clinical response <100 kg: 162 mg every other week, may increase to weekly based on clinical response

≥100 kg: 162 mg weekly

GCA 6 mg/kg every 4 weeks with a tapering course of glucocorticoids 162 mg weekly with a tapering course of glucocorticoids

162 mg every other week may be used based on clinical considerations

SSc-ILD Not approved 162 mg weekly
PJIA <30 kg: 10 mg/kg every 4 weeks

≥30 kg: 8 mg/kg every 4 weeks

<30 kg: 162 mg once every 3 weeks

≥30 kg: 162 mg once every 2 weeks

SJIA <30 kg: 12 mg/kg every 2 weeks

≥30 kg: 8 mg/kg every 2 weeks

<30 kg: 162 mg once every 2 weeks

≥30 kg: 162 mg once weekly

CRS <30 kg: 12 mg/kg once

≥30 kg: 8 mg/kg single dose (with or without corticosteroids)

Not approved
COVID-19 <30 kg: 12 mg/kg single 60-minute infusion

≥30 kg: 8 mg/kg single 60-minute infusion (Avtozma, Tofidence, and Tyenne only)

Not approved

*Note: Tofidence is only administered intravenously.

FDA-Reported Adverse Effects and Contraindications

Laboratory-Based Contraindications and Monitoring

Parameter Indication FDA Guidance
Alanine aminotransferase (ALT) / Aspartate aminotransferase (AST) RA, GCA, SSc-ILD Do not initiate if ALT or AST >1.5 x ULN (Upper Limit of Normal); discontinue if ALT or AST >5 × ULN
COVID-19 Do not initiate if ALT or AST >10× ULN
Absolute neutrophil count (ANC) RA, GCA, SSc-ILD Do not initiate if ANC <2000/mm³
COVID-19 Do not initiate if ANC <1000/mm³
All indications Do not administer if ANC <500/mm³
Platelet count RA, GCA, SSc-ILD Do not initiate if platelet count <100,000/mm³
COVID-19 Do not initiate if platelet count <50,000/mm³
All indications Do not administer if platelet count <50,000/mm³
Lipids All indications Monitor lipid panel for hyperlipidemia

Common Adverse Effects

  1. Infectious: Upper respiratory tract infections, bronchitis, nasopharyngitis, urinary tract infection
  2. Gastrointestinal: Abdominal pain, gastritis, constipation, diarrhea, nausea
  3. Hematologic and Metabolic: Hypokalemia, hypercholesterolemia
  4. Dermatologic and Injection-related: Rash, injection site reactions, mouth ulceration
  5. Neurologic and Systemic: Headache, dizziness, anxiety, insomnia
  6. Cardiovascular: Hypertension

Serious Warnings and Precautions

  • Serious infections have been reported with tocilizumab use. Tocilizumab should not be administered during an active infection and should be discontinued until the infection is adequately controlled.
  • Gastrointestinal perforation has been reported, particularly in patients with underlying risk factors.
  • Hepatotoxicity, including elevations in ALT and AST, have been observed during treatment. Liver function tests should be monitored during therapy, and treatment initiation or continuation should follow FDA-specified laboratory thresholds.
  • Neutropenia and thrombocytopenia have been observed with tocilizumab therapy. Complete blood count monitoring is recommended, and treatment should be withheld or discontinued according to FDA-approved absolute neutrophil count and platelet thresholds as described in the table above.
  • Hypersensitivity reactions, including serious allergic reactions, have been reported. Tocilizumab should be discontinued immediately and appropriate medical management initiated if a hypersensitivity reaction occurs.
  • Demyelinating disorders have been reported, and caution is advised in patients with a history of demyelinating disease.
  • Based on animal studies, tocilizumab may cause fetal harm when administered during pregnancy.[1][3][4][5]

Applications of Tocilizumab in Ophthalmology

Outside of RA, GCA, SSc-ILD, PJIA, SJIA, CRS, and COVID-19, there has been increasing interest in exploring TCZ as a potential treatment for other ophthalmic conditions, particularly thyroid eye disease (TED) and uveitic macular edema (UME).

In TED, proinflammatory and Th1-derived cytokines, particularly IL-6, are markedly upregulated during the active phase of disease.[6] IL-6 promotes hyaluronan synthesis by orbital fibroblasts, contributing to the accumulation of glycosaminoglycans that cause tissue expansion and edema.[7]

Likewise, studies have shown that high levels of IL-6 were found in the aqueous humor of patients with uveitis. Recently, Matas et al. showed a correlation between high serum levels of IL-6 and poor UME prognosis, whereas high levels of circulating lymphocytes T regulators were associated with UME resolution.[8][9] IL-6 functions as a pleiotropic pro-inflammatory cytokine that amplifies intraocular inflammation through promotion of Th17 differentiation, B-cell activation, and upregulation of vascular endothelial growth factor (VEGF), collectively contributing to blood-retinal barrier breakdown and increased vascular leakage.[10]

IL-6 receptor blockade directly targets these pathogenic pathways, providing a mechanistically grounded therapeutic strategy in using TCZ as a potential treatment for these two conditions.[10][11]

Tocilizumab and Thyroid Eye Disease

Mild TED

Most cases of TED are mild and remain stable, improve spontaneously, or are managed with conservative measures (lubricants, cold compresses, selenium supplementation, and prisms for diplopia).[12]

Moderate to Severe TED

Moderate-to-severe active disease warrants aggressive therapy. First-line management is intravenous glucocorticoids given as 12 weekly infusions: 6 methylprednisolone infusions at 0.5 g followed by 6 at 0.25 g, for a cumulative dose of 4.5 g.[13]

However, approximately 20-30% of patients do not respond to steroids, and approximately 10-20% of patients experience relapses after drug withdrawal. This called for the search for alternative therapeutic approaches, with TCZ being a promising candidate.[12]

Additional information regarding management of TED using TCZ is also available in the Biologics for Thyroid Eye Disease and Tocilizumab for Management of Graves Orbitopathy Eyewiki articles.

Dosing and Routes of Administration

While there are no official guidelines on the administration and dosing of TCZ in treatment of TED, studies have generally shown it being administered as an IV infusion (8 mg/kg monthly) or SC injection (162-mg SC weekly).

Clinical Evidence Supporting Use of TCZ in TED

Study Population TCZ Regimen Reported Outcomes
Case report[14] 52-year-old woman 480 mg IV monthly for 3 months Clinical Activity Score (CAS) improved from 6 to 0

2-3 mm reduction in inferior rectus muscle thickness, and restoration of baseline physical appearance[14]

Case report[15] 81-year-old woman 8 mg/kg IV monthly Visual acuity (VA) improved from counting fingers OD and 20/200 OS to 20/30 OU

CAS 6 → 2 within 2 months, and thyroid-stimulating immunoglobulin (TSI) declined from 954% to 225% over 5 months

Case report[15] 34-year-old woman 8 mg/kg IV monthly CAS 6 → 1; TSI 432% → 165% in 4 months
Case report[16] 60-year-old man 8 mg/kg IV monthly BCVA improved from 0.5/0.4 → 0.2/0.0 logMAR (OD/OS); IOP 27 → 20 mmHg bilaterally

Mild lid retraction improvement

Case report[17] 9-year-old girl 8 mg/kg IV monthly for 4 months Proptosis 22/22 → 20/19 mm (OD/OS); ocular pain resolved
Case report[18] 13-year-old girl 4 mg/kg IV monthly for 4 months TSHR antibody 26.1 → 1.9 U/L; symptom resolution
Case report[19] 70-year-old woman (1 of 6 patients) 8 mg/kg IV monthly Anti-TSHR antibody >40 → 25 IU/L over 5 months
Case series[19] 43-year-old man (1 of 6 patients) 8 mg/kg IV monthly CAS 7 → 1 after first infusion; VA recovery by 4 months
Case series[20] 64-year-old woman (1 of 3 patients) 162 mg SC weekly for 4 months CAS 6 → 1; TSI 676 → 76
Cohort[21] 10 patients 8 mg/kg IV for 6 months → 162 mg SC weekly for 6 months, followed by every 2 weeks for 6 months Mean CAS 4.8 → 0.7; Mean TSHR Ab 12.8 → 3.2 U/L; Mean proptosis −2.9 mm; diplopia resolved in 7 patients
Cohort[22] 54 patients 8 mg/kg IV for 4 months Mean CAS 6.7 → 0.4; Mean TRAb 69.0 → 17.3 U/L; proptosis 21.8 → 19.5 mm

Diplopia in primary gaze resolved in 7 patients, diplopia in extreme gaze decreased from 28 to 11 patients, upper eyelid edema resolved completely, and extraocular motility improved in most patients, especially in upgaze and adduction

Cohort[23] 9 patients 162 mg SC weekly for 8 weeks Mean CAS 4 → 1.2; TSI declined in a subcohort of 4 patients within 9 weeks of the first injection
Cohort[24] 11 patients 8 mg/kg IV monthly Most patients achieved disease inactivation (CAS <4 and ≥2-point reduction) after a median of 5 doses

Proptosis improved in 6 of 8 patients (≥2 mm reduction); diplopia resolved in 3 of 8 patients.

Cohort[25] 18 patients Not specified Mean CAS −5.9; TSI −76%; proptosis improved in 13 (mean -3.9 mm); EOM improved in 15 patients, and diplopia improved in 7 of 13 patients.
Cohort[26] 5 patients Not specified Medial and lateral rectus thickness and chemosis reduced; Mean CAS 5 → 1
Cohort[27] 8 patients Not specified Mean TRAb 291.9% → 172.7%; CAS 4.1 → 1.1; exophthalmometry 21.2 → 19.3 mm
Cohort[28] 48 patients Not specified Mean BCVA 0.78 → 0.90; Mean CAS 4.64 → 1.05; Mean IOP 19.05 → 16.73 at 1 year
RCT[29] Adults 8 mg/kg IV monthly for 3 months vs placebo At week 16, TCZ-treated patients had a significantly higher proportion of patients achieving CAS improvement ≥2 and scoring CAS <3 than placebo group.

Anti-TPO showed a small but significant reduction at weeks 16 and 40 in TCZ-treated group versus placebo.

Conflicting Evidence

Study Population TCZ Regimen Findings
Case report[30] 50-year-old male TCZ IV (dosage unspecified) monthly ×3 Caruncle inflammation resolved, but there was minimal improvement in eyelid swelling, pain, proptosis, or diplopia (CAS 6/10). Severe arthralgias and intractable pruritus led to discontinuation of tocilizumab treatment
Case report[18] 13-year-old girl TCZ 4 mg/kg IV monthly ×4 No improvement in left-eye proptosis
RCT[29] Adults TCZ 8 mg/kg IV monthly ×3 vs placebo Exophthalmos showed significant median reduction at week 16 in the TCZ group versus placebo, but no significant difference at week 40; no significant differences in anti-TG, TSI, or TSH levels between groups
Observational[22] Patients treated with TCZ Additional TCZ dosing (1–8 additional doses) reported in recurrent TED TED recurrence following TCZ treatment has been reported in several patients, typically requiring further treatment with additional TCZ doses

Side Effects

System Adverse effects
General Mild asthenia[14][20][22]
Dermatologic Arthralgias and intractable pruritus[22][30]
Hypersensitivity Anaphylactic shock with bronchospasm[22]
Hematologic Neutropenia[21][22][24][28][29]; leukopenia[22]; thrombocytopenia[16][22][29]
Infectious Upper respiratory tract infection[21][22][29]; urinary tract infection[29]; gastroenteritis[29]; skin infection[21]; cellulitis[22]; external otitis[28]; otitis media[28]
Musculoskeletal Costal osteitis[28]
Oral/Dental Gingival hyperplasia[28]
Metabolic Hypercholesterolemia[22][31]
Hepatic Hypertransaminasemia[22]

Management of Uveitic Macular Edema

Standard Management

Standard management of uveitic macular edema (UME) focuses on control of intraocular inflammation and macular edema using local and systemic corticosteroids, intravitreal therapies, and anti–vascular endothelial growth factor agents, as reviewed in detail on the EyeWiki page for Treatment of Uveitis.

Tocilizumab: Dosing and Administration

As with TED, there are no formal guidelines for the administration and dosing of TCZ in the treatment of UME. Across published studies, TCZ has been administered as an intravenous infusion at doses of 4 mg/kg every 4 weeks, 8 mg/kg every 2 weeks, or 8 mg/kg every 4 weeks, or as a subcutaneous injection at 162 mg every 1, 2, or 3 weeks.

Subcutaneous TCZ has demonstrated lower efficacy than intravenous TCZ for juvenile idiopathic arthritis–associated uveitis in a small case series; however, randomized controlled trials in RA have shown comparable efficacy between SC and IV formulations. From a practical standpoint, SC administration is often preferred because it improves patient convenience, minimizes disruption to school attendance in pediatric patients, and reduces health-care resource utilization. Nevertheless, the presence of the blood–aqueous and blood–retinal barriers may limit intraocular drug penetration, suggesting that higher systemic drug exposure may be required to achieve therapeutic efficacy in ocular inflammation compared with other systemic disease sites.[32]

Major Clinical Studies

Study Population TCZ Regimen Key Findings
Multicenter meta-analysis[33] 374 patients with refractory noninfectious uveitis
  • Predominantly IV 8 mg/kg every 2–4 weeks
  • Occasional SC dosing (162 mg or 2.9 mg/kg every 1–3 weeks)
  • Pooled macular edema resolution rate 93.2% (I² = 0.00%, p = 0.43)
  • Mean central macular thickness (CMT) decreased by 143.6 μm
  • VA improved by −0.29 logMAR (~3 Snellen lines)
  • Inflammation control rates (75%) were comparable to those of anti-TNF agents
Multicenter retrospective study[34] 204 patients
  • Infliximab IV 5 mg/kg at 0, 2, 6, and every 4-6 weeks (n=69)
  • Adalimumab SC 80 mg followed by 40 mg for 14 days (n=80)
  • TCZ IV 8 mg/kg every 4 weeks (n=39)
  • TCZ SC 162 mg weekly (n=16)
  • TCZ was associated with approximately twofold higher odds of complete UME resolution compared with anti-TNF-α agents (infliximab and adalimumab)
  • Central foveal thickness decreased from 516 μm to 271 μm at 6 months
APTITUDE trial[32] Multicenter, single-arm, phase 2 study evaluating TCZ in 21 children with PJIA-associated uveitis refractory to anti-TNF therapy.
  • <30 kg: 162 mg SC once every 3 weeks
  • ≥30 kg: 162 mg SC once every 2 weeks
 The trial required more than 7 patients to respond to treatment, defined as a two-step decrease (to zero) from baseline on the Standardization of Uveitis Nomenclature at 12 weeks, to justify progression to a phase 3 study. While the trial did not reach phase 3, it nonetheless revealed beneficial outcomes that warrant further investigation:
  • 7 patients responded to treatment
  • 3 patients (14%) demonstrated a one-step improvement in uveitis activity by week 24
  • This suggests that longer treatment duration may be associated with increased response rate
  • Among 4 patients with cystoid ME at baseline, 3 achieved complete resolution with TCZ[32]
STOP-Uveitis trial[35] Randomized, open-label safety, efficacy, and bioactivity clinical trial evaluating TCZ treatment of NIU in 37 patients.
  • Group 1: 4 mg/kg IV every 4 weeks (n=18)
  • Group 2: 8 mg/kg IV every 4 weeks (n=19)
 Infusions were given from baseline until month 5 (for a total of 6 infusions). Researchers found that:
  • The mean change in CMT at 6 months was -83.88 ± 136.1 µm (131.5 ± 41.56 µm in Group 1 and -38.92 ± 13.7 µm in Group 2); no statistically significant difference was observed between the treatment groups
  • The mean change in VA at 6 months was an improvement of 8.22 ± 11.83 ETDRS letters, with gains of 10.9 ± 14.6 letters in Group 1 and 5.5 ± 7.8 letters in Group 2; no statistically significant difference was observed between the two groups[35]

Adverse Effects Reported in Uveitic Macular Edema Studies

System Adverse effects
General Fatigue[36]; dizziness[36]; nausea[36]; chest tightness[36]
Hematologic Neutropenia[36][37][38]; thrombocytopenia[39]; anemia[39]
Infectious Upper respiratory tract infections; pneumonia[37][38][39]; septicemia[38]; urinary tract infections[38]; viral conjunctivitis[39]; bullous impetigo[39]
Dermatologic Skin rash[38]; hand and limb blisters[36]
Gastrointestinal Abdominal pain[36]; intestinal perforation[38]
Metabolic Dyslipidemia[38]
Hypersensitivity / Infusion-related Infusion reaction[40]; angioedema[36]

Summary of Current Evidence

Across meta-analyses, observational cohorts, and prospective clinical trials, TCZ has demonstrated consistent efficacy in reducing macular edema, improving visual acuity, and controlling intraocular inflammation in refractory UME. Available evidence suggests that TCZ may provide comparable or superior anatomic outcomes relative to anti-TNF-α agents in selected populations, although optimal dosing strategies, route of administration, and long-term durability of response remain areas of ongoing investigation.

Taken together, current data support IL-6 inhibition as a potentially effective therapeutic strategy in both TED and UME. However, serious adverse events, including intestinal perforation, pneumonia, and septicemia, have been reported and, in some cases, have led to discontinuation of TCZ therapy.Larger randomized clinical trials are necessary to more definitively characterize the efficacy and safety profiles of both IV and SC TCZ in these ophthalmic indications.

Most published studies have administered TCZ according to FDA-approved dosing regimens established for other systemic conditions. Whether these dosing strategies represent the optimal therapeutic approach for TED and UME remains uncertain. Notably, SC TCZ has been estimated to be more than threefold less expensive than IV therapy, even excluding ancillary infusion-related costs. Prior studies in RA have demonstrated comparable safety and efficacy between SC and IV formulations.[23] Further investigation is therefore warranted to determine the optimal route of administration and whether ophthalmic-specific dosing adjustments may improve outcomes in patients with TED and UME.

References

  1. ↑ 1.0 1.1 1.2 DailyMed - ACTEMRA- tocilizumab injection, solution, concentrate ACTEMRA- tocilizumab injection, solution ACTEMRA ACTPEN- tocilizumab injection, solution. Accessed February 1, 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=2e5365ff-cb2a-4b16-b2c7-e35c6bf2de13#IFU
  2. ↑ Venkiteshwaran A. Tocilizumab. MAbs. 2009;1(5):432-438. doi:10.4161/mabs.1.5.9497
  3. ↑ 3.0 3.1 DailyMed - AVTOZMA- tocilizumab injection, solution. Accessed February 1, 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=581c288f-8015-40ef-a4c3-683c96db193d
  4. ↑ 4.0 4.1 DailyMed - TOFIDENCE- tocilizumab injection. Accessed February 1, 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=00529b23-850a-42b9-a152-125a95b5242c
  5. ↑ 5.0 5.1 DailyMed - TYENNE- tocilizumab-aazg injection, solution. Accessed February 1, 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ad76441d-da59-47df-8d9d-2243005180f0
  6. ↑ Leszczynska A, Molins B, Fernández E, Adán A, Ortiz-Perez S. Cytokine production in thyroid eye disease: in vitro effects of dexamethasone and IL-6 blockade with tocilizumab. Graefes Arch Clin Exp Ophthalmol. 2019;257(10):2307-2314. doi:10.1007/s00417-019-04419-7
  7. ↑ Khong JJ, McNab AA, Ebeling PR, Craig JE, Selva D. Pathogenesis of thyroid eye disease: review and update on molecular mechanisms. British Journal of Ophthalmology. 2016;100(1):142-150. doi:10.1136/bjophthalmol-2015-307399
  8. ↑ Matas J, Llorenç V, Fonollosa A, et al. Systemic Regulatory T Cells and IL-6 as Prognostic Factors for Anatomical Improvement of Uveitic Macular Edema. Front Immunol. 2020;11:579005. doi:10.3389/fimmu.2020.579005
  9. ↑ Errera MH, Pratas A, Fisson S, et al. Cytokines, chemokines and growth factors profile in human aqueous humor in idiopathic uveitis. PLoS One. 2022;17(1):e0254972. doi:10.1371/journal.pone.0254972
  10. ↑ 10.0 10.1 Mesquida M, Molins B, Llorenç V, Sainz de la Maza M, Adán A. Long-term effects of tocilizumab therapy for refractory uveitis-related macular edema. Ophthalmology. 2014;121(12):2380-2386. doi:10.1016/j.ophtha.2014.06.050
  11. ↑ McElvaney OJ, Curley GF, Rose-John S, McElvaney NG. Interleukin-6: obstacles to targeting a complex cytokine in critical illness. Lancet Respir Med. 2021;9(6):643-654. doi:10.1016/S2213-2600(21)00103-X
  12. ↑ 12.0 12.1 Genere N, Stan MN. Current and Emerging Treatment Strategies for Graves’ Orbitopathy. Drugs. 2019;79(2):109-124. doi:10.1007/s40265-018-1045-9
  13. ↑ Wiersinga WM, Eckstein AK, Žarković M. Thyroid eye disease (Graves' orbitopathy): clinical presentation, epidemiology, pathogenesis, and management. Lancet Diabetes Endocrinol. 2025;13(7):600-614. doi:10.1016/S2213-8587(25)00066-X
  14. ↑ 14.0 14.1 14.2 Butnaru D, Pérez-Moreiras JV, Sánchez-Ramón S. Anti-IL-6R therapy on Graves’ ophthalmopathy. Clinical Immunology. 2013;147(2):120-121. doi:10.1016/j.clim.2013.02.017
  15. ↑ 15.0 15.1 Russell DJ, Wagner LH, Seiff SR. Tocilizumab as a steroid sparing agent for the treatment of Graves’ orbitopathy. American Journal of Ophthalmology Case Reports. 2017;7:146-148. doi:10.1016/j.ajoc.2017.07.001
  16. ↑ 16.0 16.1 Mehmet A, Panagiotopoulou EK, Konstantinidis A, et al. Α Case of Severe Thyroid Eye Disease Treated with Tocilizumab. Acta Med (Hradec Kralove, Czech Repub). 2021;64(1):64-69. doi:10.14712/18059694.2021.12
  17. ↑ Albrashdi S, Alsharqi H, Habroosh F, Eatamadi H. Tocilizumab use in pediatric thyroid eye disease: First documented case. American Journal of Ophthalmology Case Reports. 2022;25:101387. doi:10.1016/j.ajoc.2022.101387
  18. ↑ 18.0 18.1 Moleiro AF, Vilares-Morgado R, Alves GC, et al. Tocilizumab as a Useful Tool for Thyroid Eye Disease in Pediatric Population: A Case Report. Case Rep Ophthalmol. 2022;13(3):868-875. doi:10.1159/000526546
  19. ↑ 19.0 19.1 Abeillon-du Payrat J, Grunenwald S, Gall E, Ladsous M, Raingeard I, Caron P. Graves’ orbitopathy post-SARS-CoV-2 vaccines: report on six patients. J Endocrinol Invest. 2023;46(3):617-627. doi:10.1007/s40618-022-01955-8
  20. ↑ 20.0 20.1 Stevens SM, Pirakitikulr N, Lee BW. Subcutaneous tocilizumab for active thyroid eye disease refractory to orbital radiation and systemic steroids in tobacco smokers. Taiwan Journal of Ophthalmology. 2022;12(1):39. doi:10.4103/tjo.tjo_59_21
  21. ↑ 21.0 21.1 21.2 21.3 Moi L, Hamedani M, Ribi C. Long‐term outcomes in corticosteroid‐refractory Graves’ orbitopathy treated with tocilizumab. doi:10.1111/cen.14655
  22. ↑ 22.00 22.01 22.02 22.03 22.04 22.05 22.06 22.07 22.08 22.09 22.10 22.11 Pérez-Moreiras JV, Varela-Agra M, Prada-Sánchez MC, Prada-Ramallal G. Steroid-Resistant Graves’ Orbitopathy Treated with Tocilizumab in Real-World Clinical Practice: A 9-Year Single-Center Experience. Journal of Clinical Medicine. 2021;10(4). doi:10.3390/jcm10040706
  23. ↑ 23.0 23.1 Silkiss RZ, Paap MK, Roelofs KA, Agi J, Weis E. Treatment of corticosteroid-resistant thyroid eye disease with subcutaneous tocilizumab. Canadian Journal of Ophthalmology. 2021;56(1):66-70. doi:10.1016/j.jcjo.2020.07.020
  24. ↑ 24.0 24.1 Pampín-Sánchez R, Martínez-Mugica-Barbosa C, Fonseca-Aizpuru EM, Barbazán-Vázquez FJ, Fernández-González B, Buznego-Súárez L. Outcome of tocilizumab treatment in corticosteroid-resistant thyroid eye disease. Medicina Clínica (English Edition). 2023;160(3):113-117. doi:10.1016/j.medcle.2022.05.028
  25. ↑ Pérez-Moreiras JV, Álvarez-López A, Gómez EC. Treatment of Active Corticosteroid-Resistant Graves’ Orbitopathy. Ophthalmic Plastic & Reconstructive Surgery. 2014;30(2):162. doi:10.1097/IOP.0000000000000037
  26. ↑ de-Pablo-Gómez-de-Liaño L, Fernández-Vigo JI, Troyano-Rivas J, Niño-Rueda C, Romo-López Á, Gómez-de-Liaño R. Response to tocilizumab treatment in Graves’ ophthalmopathy by measuring rectus muscle thickness and chemosis using optical coherence tomography. Archivos de la Sociedad Española de Oftalmología (English Edition). 2018;93(8):386-391. doi:10.1016/j.oftale.2018.07.001
  27. ↑ Ceballos-Macías José J, Rivera-Moscoso R, Flores-Real Jorge A, et al. Tocilizumab in glucocorticoid-resistant graves orbitopathy. A case series report of a mexican population. Annales d’Endocrinologie. 2020;81(2):78-82. doi:10.1016/j.ando.2020.01.003
  28. ↑ 28.0 28.1 28.2 28.3 28.4 28.5 Sánchez-Bilbao L, Martínez-López D, Revenga M, et al. Anti-IL-6 Receptor Tocilizumab in Refractory Graves’ Orbitopathy: National Multicenter Observational Study of 48 Patients. Journal of Clinical Medicine. 2020;9(9). doi:10.3390/jcm9092816
  29. ↑ 29.0 29.1 29.2 29.3 29.4 29.5 29.6 Perez-Moreiras JV, Gomez-Reino JJ, Maneiro JR, et al. Efficacy of Tocilizumab in Patients With Moderate-to-Severe Corticosteroid-Resistant Graves Orbitopathy: A Randomized Clinical Trial. American Journal of Ophthalmology. 2018;195:181-190. doi:10.1016/j.ajo.2018.07.038
  30. ↑ 30.0 30.1 Mohamed A, Tzoulis P, Kossler AL, Dosiou C. New Onset or Deterioration of Thyroid Eye Disease After mRNA SARS-CoV-2 Vaccines: Report of 2 Cases and Literature Review. J Clin Endocrinol Metab. 2023;108(4):979-985. doi:10.1210/clinem/dgac606
  31. ↑ Smith LD, Moscato EE, Seiff SR. Tocilizumab for the Management of Thyroid-Associated Orbitopathy. Ophthalmic Plastic & Reconstructive Surgery. 2022;38(2):188. doi:10.1097/IOP.0000000000002027
  32. ↑ 32.0 32.1 32.2 Ramanan AV, Dick AD, Guly C, et al. Tocilizumab in patients with anti-TNF refractory juvenile idiopathic arthritis-associated uveitis (APTITUDE): a multicentre, single-arm, phase 2 trial. Lancet Rheumatol. 2020;2(3):e135-e141. doi:10.1016/S2665-9913(20)30008-4
  33. ↑ Kang H, Wu X, Xu H, Huang Y, Zhang M. Effectiveness and safety of tocilizumab in refractory noninfectious uveitis: a systematic review and meta-analysis. Front Pharmacol. 2025;16:1694311. doi:10.3389/fphar.2025.1694311
  34. ↑ Leclercq M, Andrillon A, Maalouf G, et al. Anti–Tumor Necrosis Factor α versus Tocilizumab in the Treatment of Refractory Uveitic Macular Edema: A Multicenter Study from the French Uveitis Network. Ophthalmology. 2022;129(5):520-529. doi:10.1016/j.ophtha.2021.11.013
  35. ↑ 35.0 35.1 Sepah YJ, Sadiq MA, Chu DS, et al. Primary (Month-6) Outcomes of the STOP-Uveitis Study: Evaluating the Safety, Tolerability, and Efficacy of Tocilizumab in Patients With Noninfectious Uveitis. American Journal of Ophthalmology. 2017;183:71-80. doi:10.1016/j.ajo.2017.08.019
  36. ↑ 36.0 36.1 36.2 36.3 36.4 36.5 36.6 36.7 Silpa-archa S, Oray M, Preble JM, Foster CS. Outcome of tocilizumab treatment in refractory ocular inflammatory diseases. Acta Ophthalmologica. 2016;94(6):e400-e406. doi:10.1111/aos.13015
  37. ↑ 37.0 37.1 Mesquida M, Molins B, Llorenç V, et al. TWENTY-FOUR MONTH FOLLOW-UP OF TOCILIZUMAB THERAPY FOR REFRACTORY UVEITIS-RELATED MACULAR EDEMA. RETINA. 2018;38(7):1361. doi:10.1097/IAE.0000000000001690
  38. ↑ 38.0 38.1 38.2 38.3 38.4 38.5 38.6 Khitri MY, Bartoli A, Maalouf G, et al. Tocilizumab in Behçet Disease: A Multicenter Study of 30 Patients. The Journal of Rheumatology. 2023;50(7):916-923. doi:10.3899/jrheum.221106
  39. ↑ 39.0 39.1 39.2 39.3 39.4 Calvo-Río V, Santos-Gómez M, Calvo I, et al. Anti–Interleukin-6 Receptor Tocilizumab for Severe Juvenile Idiopathic Arthritis–Associated Uveitis Refractory to Anti–Tumor Necrosis Factor Therapy: A Multicenter Study of Twenty-Five Patients. Arthritis & Rheumatology. 2017;69(3):668-675. doi:10.1002/art.39940
  40. ↑ Atienza-Mateo B, Calvo-Río V, Beltrán E, et al. Anti-interleukin 6 receptor tocilizumab in refractory uveitis associated with Behçet’s disease: multicentre retrospective study. Rheumatology (Oxford). 2018;57(5):856-864. doi:10.1093/rheumatology/kex480
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