갑상샘눈병증 환자에서 사용한 피하 토실리주맙의 효과
Subcutaneous Tocilizumab for Thyroid Eye Disease
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 고식적인 치료에도 반응하지 않는 갑상샘눈병증 환자 2명에서 피하 토실리주맙 주사치료를 시행하여 효과를 보고하고자 한다. 증례요약: (증례 1) 52세 남성이 3개월 전 시작된 갑상샘눈병증으로 내원하였으며 임상활성도는 5점으로 측정되었다. 고용량부신피질호르몬 주사요법 및 methotrexate 경구요법에도 증상의 호전을 보이지 않아 2주 간격 4회의 피하 토실리주맙 주사치료를 시행하였다. 치료 2주 후 임상활동도 점수는 0점으로 감소하였으며 6개월 이상의 경과 관찰에서 재발은 없었다. (증례 2) 내원 3개월 전 갑상샘항진증이 진단된 37세 여성이 충혈과 눈꺼풀 발적을 주소로 내원하였다. 임상활성도는 4점, 갑상샘자극항체는 475%였다. 고용량부신피질호르몬 주사요법과 methotrexate 경구요법에도 호전이 없어 2주 간격 4회의 피하 토실리주맙 주사치료를 시행하였다. 주사치료 후 임상활성도 점수는 1점으로 감소하였으며 6개월의 경과 관찰에서 재발은 없었다. 결론: 고용량의 부신피질호르몬 주사치료와 면역억제제치료에도 반응하지 않는 갑상샘눈병증에서 피하 토실리주맙 주사치료는 간편하며 효과적으로 증상을 조절할 수 있는 치료의 선택이 될 수 있다.
Abstract
Purpose: To demonstrate the efficacy of subcutaneous tocilizumab (TCZ-SC) treatment for recalcitrant thyroid eye disease (TED) refractory to intravenous methylprednisolone (MP) and oral methotrexate (MTX). Case summary: (Case 1) A 52-year-old man, smoker, with hyperthyroidism presented with a 3-months history of TED. The initial clinical activity score (CAS) was 5 (total score of 7). High-dose intravenous MP and oral MTX failed to improve the symptoms. He was treated with four doses of 162 mg TCZ-SC at an interval of 2 weeks. Pre-treatment laboratory test results were within normal limits. CAS was reduced to 2 weeks after the final injection, and there were no recurrences during the 6-month follow-up. (Case 2) A 37-year-old woman, non-smoker, with a 3-months history of hyperthyroidism presented with conjunctival injection and upper eyelid erythema. The initial CAS was 4, and thyroid-stimulating immunoglobulin level was raised (475% of normal). The symptoms did not improve with 7.5 g intravenous MP and oral MTX. The patient was treated with 162 mg TCZ-SC. Pre-treatment laboratory test results were within normal limits. CAS was reduced to 1 after the final injection, and there were no recurrences during the 6-months follow-up. Conclusions: TCZ-SC improves symptoms of corticosteroid-resistant TED, and may be a reasonable option in recalcitrant TED cases. However, further studies are required to justify the use of TCZ-SC for TED.
참고문헌 (15)
- Bartalena L, "The 2016 European Thyroid Association", European Group on Graves’ orbitopathy guidelines for the management of Graves’ orbitopathy, 2016, pp.5, 9~26
- Bartalena L, "Efficacy and safety of three different cumulative doses of intravenous methylprednisolone for moderate to severe and active Graves’ orbitopathy", J Clin Endocrinol Metab, 97, pp.4454~4463 (2012)
- 이채은, "Chemokine Expression during Adipogenesis and Inflammation in Orbital Fibroblasts from Patients with Graves’ Orbitopathy", Korean Journal of Ophthalmology, 34(3), pp.192~202 (2020), 대한안과학회[DOI]
- Khong JJ, "Pathogenesis of thyroid eye disease : review and update on molecular mechanisms", Br J Ophthalmol, 100, pp.142~150 (2016)
- Oldfield V, "Tocilizumab : a review of its use in the management of rheumatoid arthritis", Drugs, 69, pp.609~632 (2009)
- "Actemra (tocilizumab). Prescribing information" (2020)[URL]
- Le RQ, "FDA approval summary : tocilizumab for treatment of chimeric antigen receptor T cell-induced severe or life-threatening cytokine release syndrome", Oncologist, 23, pp.943~947 (2018)
- Perez-Moreiras JV, "Efficacy of tocilizumab in patients with moderate-to-severe corticosteroidresistant Graves orbitopathy : a randomized clinical trial", Am J Ophthalmol, 195, pp.181~190 (2018)
- Copperman T, "Subcutaneous tocilizumab for thyroid eye disease : simplified dosing and delivery", Ophthalmic Plast Reconstr Surg, 35, pp.e64~e66 (2019)
- Pérez-Moreiras JV, "Treatment of active corticosteroid-resistant Graves’ orbitopathy", Ophthalmic Plast Reconstr Surg, 30, pp.162~167 (2014)
- Anvari M, "Graves’ disease and gene polymorphism of TNF-α, IL-2, IL-6, IL-12, and IFN-γ", Endocrine, 37, pp.344~348 (2010)
- Slowik M, "CD8+CD28-lymphocytes in peripheral blood and serum concentrations of soluble interleukin 6 receptor are increased in patients with Graves’ orbitopathy and correlate with disease activity", Endocr Res, 37, pp.89~95 (2012)
- Lehmann GM, "Immune mechanisms in thyroid eye disease", Thyroid, 18, pp.959~965 (2008)
- Burmester GR, "A randomised, double-blind, parallel-group study of the safety and efficacy of subcutaneous tocilizumab versus intravenous tocilizumab in combination with traditional disease-modifying antirheumatic drugs in patients with moderate to severe rheumatoid arthritis(SUMMACTA study)", Ann Rheum Dis, 73, pp.69~74 (2014)
- Hamed Azzam S, "Tocilizumab for thyroid eye disease", Cochrane Database Syst Rev, 11, pp.CD012984~ (2018)