TOPLINE:

Long-term treatment with tocilizumab was effective in patients with moderate-to-severe thyroid eye disease (TED) that was resistant to corticosteroids, with 58% of patients achieving clinical improvement at 6 months and benefits continuing through 12 months. The treatment showed durability, with a relapse rate below 10% at 6 months after discontinuation.

METHODOLOGY:

• Researchers conducted a single-center retrospective study to evaluate the efficacy of long-term tocilizumab therapy in patients with corticosteroid-resistant moderate-to-severe TED.
• They analyzed 26 adults who received tocilizumab (8 mg/kg via intravenous infusion every 4 weeks or 162 mg subcutaneously every week) for 6 months and then a half dose (4 mg/kg intravenously every 4 weeks or 162 mg subcutaneously every 2 weeks) for another 6 months; no patient received corticosteroids while on treatment.
• Patients were included if the onset of disease occurred less than 12 months before enrollment and they had received 12 weekly corticosteroid infusions.
• The primary endpoint was the proportion of patients with a clinical activity score below 3 after 6 months of tocilizumab therapy.
• MRI scans were obtained before and 6 months after tocilizumab therapy; scans from 22 patients were analyzed to assess the inferior and medial rectus muscles.

TAKEAWAY:

• At 6 months, 58% of patients achieved a clinical activity score less than 3 (P < .001); the median clinical activity score was lower at months 3, 6, 9, 12, and 18 than at baseline.
• Only 8.3% of patients experienced relapse at month 18, occurring at a median time of 3.5 months after the last tocilizumab injection.
• After a follow-up period of 18 months, the proportions of patients with proptosis and diplopia decreased, and the median intraocular pressure and levels of thyroid-stimulating immunoglobulin declined significantly.
• An analysis of MRI scans found the signal intensity ratio and the thickness of the inferior and medial rectus muscles decreased at month 6 compared with that at baseline.

IN PRACTICE:

“In addition to demonstrating control of the disease, our study indicates a low relapse rate of 8.3% at 18 months,” the researchers reported. “Additionally, MRI could assist physicians in managing TED,” they wrote.

SOURCE:

The study was led by Florian Dalmas, MD, of the Department of Ophthalmology at Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France. It was published online on November 10, 2025, in the European Journal of Endocrinology. 

LIMITATIONS:

The retrospective design and relatively small patient population were key limitations of the study, according to the researchers. The two different tocilizumab regimens were combined into a single cohort. Patients with active TED for more than 12 months prior to initiation of tocilizumab were excluded from the study.

DISCLOSURES:

No specific funding was received. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.