Name

Efficacité du tocilizumab dans 3 cas de polychondrite atrophiante avec atteinte oculaire

To report the efficacy of anti-interleukine-6 (IL-6) antibody in treating 3 cases of relapsing polychondritis with ocular involvement.

Relapsing polychondritis (RP) is a rare autoimmune disorder characterized by destructive inflammation in the cartilaginous tissue throughout the body. Ocular manifestations occur in 51-65% of cases. The most common sites of involvement are the conjunctiva, the episclera and the sclera. RP is usually treated with glucocorticoids and conventional immunosuppressive agents, or sometimes with anti-tumor necrosis factor-alpha (TNF-alpha) agents. However it is not clear what should be the next therapeutic option if these agents are ineffective. According to the literature, a recombinant anti-IL-6 receptor monoclonal antibody, tocilizumab, has been successfully administered in patient with refractory RP, as a salvage therapy. Few cases report treatment of ocular manifestations with tocilizumab. We report herein, three cases of relapsing polychondritis complicated with scleritis or sclera-uveitis, refractory to conventional immunosuppressive and anti-TNF-alpha agents successfully treated with tocilizumab.

All three patients demonstrated complete and sustained clinical improvement. The daily dose of oral prednisolone was reduced to 5 mg in 2 patients and stopped in one. No serious side effects were noted.

Serum interleukine-6 levels, were found to be highly increased in some cases of RP, and normal in others. These facts could explain this variability of tocilizumab effect on RP. RP with high serum interleukin 6 levels may be resistant to steroids and anti-TNF-alpha agents and responsive to tocilizumab.

These three cases suggest that anti-IL-6 receptor antibody may be an effective alternative to conventional immunosuppressive and anti-TNF-alpha in the treatment of relapsing polychondritis.